The Factors Affecting Severe Hemorrhage With MPCNL And The Clinical Management

Objective:To analyze the factors affecting severe hemorrhage with minimally invasive percutaneous nephrolithotomy, and to explore the prevention and control of the hemorrhage, summarize the experience in the interventional treatment of severe bleeding after MPCNL by superselective arteriolar embolization.Method:4538 cases of MPCNL in our hospital from September 2002 to December 2008 were retrospectively analyzed, 28 cases who occurred severe hemorrhage were defined as the the hemorrhage group; 200 cases of randomly selected patients in 4502 cases of non-bleeding were defined as the control group. Various patient related factors, as calculus situation, hypertension, diabetes, liver dysfunction, renal insufficiency, urinary tract infection, kidney history of previous surgery, hydronephrosis cases, whether multi-channel puncture, whether the stone in phases, were analyzed statistically, for the sake of identing the impact factors increased the rate of severe hemorrhage, and providing clinical experience to prevent and control the severe hemorrhage. And to analyze and approach the effect and the time of the arteriolar embolization.Result:Group of 28 cases of bleeding with a total amount of bleeding 900-3100ml, an average of 1200ml. 1 cases occurred in or 24h after operation, 17 cases occurred 2-7 days after, 10 cases occurred 7 days after, the degree of hydronephrosis, urinary system infection, stone surface area, diabetes, the number of puncture channel, surgical staging and surgery affect the incidence of bleeding, the use of blood transfusion, drug to stop bleeding, and local oppression, such as clipping of renal fistula made 13 cases of conservative treatment, 14 patients of conservative treatment failured or large amount of bleeding emergencyly got interventional treatment, and achieved good results.Conclusion:The huge stone, multi-channel stones removal, the complicated pre-operative urinary tract infection or diabetes, as well as prolonged operative time can arise the severe hemorrhage rate of MPCNL, severe hydronephrosis and staging the procedure are associated with reduced blood loss, as well as decrease the severe hemorrhage rate. To control the pre-operative infection and diabetes, improve the surgical skills to reduce the operative time , and for the large or complex stones or the cases with intraoperative technical complications choosing to operate in stages can help reduce the occurrence of bleeding. To whom with severe hemorrhage, we can clamp the renal fistula, give blood transfusion and hemostatic. And even the replacement nephrostomy balloon fistula, if still bleeding, interventional embolization should be as soon as possible to stop bleeding. Interventional embolization is highly selective and will not cause renal damage, is the preferred method of treatment of severe bleeding with MPCNL.