Treatment of Severe Hemorrhage in Percutaneous Nephrolithotomy
Xu Guanglong1, Zhou Liquan1,*, Tang Yong2, Qin Yulin1, Wang Xiaoming1, Huang Fu1, Pan Yi1, Tan Xi1, Huang Guanhua1
1Department of Urology, Second Affiliated Hospital of Guangxi Medical University, Nanning 530007; 2Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning 530199
Abstract：Objective： To analyze the treatment of severe bleeding during and after percutaneous nephrolithotomy（PCNL） for treating upper urinary tract calculi. Methods： The clinical data of 3184 patients with upper urinary calculi for PCNL were retrospectively analyzed, to summarize the treatment of severe bleeding. Results： A total of 3184 patients were include in the study. Serious bleeding were found in 74（2.3% ,74/3184） cases. 35 cases bleeding occurred （47.3%） during operation and 39 cases（52.7%） after operation. 52 cases （52/74, 70.3%） were cured by conservative treatment; For 19（25.7％） cases treated with selective renal artery embolization, 17 of them were cured with one operation, 1 of them was cured with twice operations, but 1 case received twice selective renal artery embolization still re-bleeding, was converted to open operation. Open operation was performed for hemostasis in 3 cases directly. No kidney was removed. Conclusion： Bleeding during or after PCNL is the complication that can’t be absolutely prevented, Standardized surgical procedure is the key to prevention bleeding during PCNL. Most patients with severe bleeding after PCNL can be controlled by conservative treatment, only a small number of patients require selective renal artery embolization （SRAE） to control bleeding. Accurately grasping the timing of SRAE is the key to successful hemostasis.
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