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目的:探讨肾结石ESWL后肾脏血肿的原因。方法:对2008年5月~2012年6月5例肾结石ESWL后肾脏血肿的临床资料进行分析并文献复习。结果:采用上海交通大学JDPN-ⅤB型液电式碎石机治疗后引起肾脏血肿3例,深圳惠康HK.ESWL-109型电磁式碎石机治疗引起2例。体型肥胖并高血压2例(其中1例糖尿病)。2例因输尿管结石梗阻感染行输尿管镜取石术后行同侧肾结石ESWL后出现肾脏血肿,2例行一侧输尿管结石ESWL后行对侧肾结石ESWL后出现肾脏血肿,1例右输尿管上段结石ESWL后部分结石上移肾内行肾结石ESWL后出现肾脏血肿。4例保守治疗痊愈(肾包膜下血肿2例,肾包膜破裂肾周血肿2例);1例肾周大血肿腹膜后扩散,输血3 500ml,行高选择性肾动脉分支栓塞治愈。结论:ESWL并非绝对安全、没有重大并发症,只有掌握合适的适应证才安全可靠,在治疗前后需要仔细观察和评估。导致肾脏血肿的易患因素有凝血功能异常、抗凝药物的使用、糖尿病、高血压、老年患者、心脏病、肥胖等因素。高低能量冲击波的交替使用,有助于提高碎石的成功率及安全性。绝大多数患者可以通过保守治疗治愈,少数需要肾动脉栓塞治疗,个别严重患者需要肾切除来挽救生命。
Objective: To investigate the causes of renal hematoma after renal stone ESWL. Methods: The clinical data of 5 cases of renal hematoma after ESWL with renal stones from May 2008 to June 2012 were analyzed and reviewed. Results: Three cases of renal hematoma were treated with JDPN-VB hydro-lithotripsy device of Shanghai Jiaotong University. Two cases were treated by Shenzhen Wellcome HK.ESWL-109 electromagnetic lithotripsy machine. Body fat and hypertension in 2 cases (including 1 case of diabetes). 2 cases of ureteral obstruction infection ureteroscopic lithotomy ipsilateral kidney stone after ESWL renal hematoma, 2 cases of ureteral calculi ESWL contralateral kidney stone after ESWL renal hematoma occurred, 1 case of right upper ureteral calculi ESWL after some of the stones on the kidney removal of renal stones after ESWL kidney hematoma. 4 cases of conservative treatment healed (2 cases of subrenal hematoma, 2 cases of renal capsule rupture of perineal hematoma); 1 case of peritoneal hematoma enlargement of peritoneal hematoma, blood transfusion 3 500ml, high-selective renal artery embolization cure. CONCLUSIONS: ESWL is not absolutely safe and has no major complications. It is safe and reliable only with appropriate indications and requires careful observation and assessment before and after treatment. The predisposing factors leading to renal hematoma are coagulation abnormalities, the use of anticoagulant drugs, diabetes, hypertension, elderly patients, heart disease, obesity and other factors. The alternating use of high and low energy shock waves helps to improve the success rate and safety of the gravel. The vast majority of patients can be cured by conservative treatment, a few require renal artery embolization treatment, individual patients in need of radical nephrectomy to save lives.