输尿管镜碎石术后肾包膜下血肿危险因素分析

目的：探讨输尿管镜碎石术后发生肾包膜下血肿的危险因素。方法：回顾性分析2006年7月～2008年12月行输尿管镜碎石术后发生肾包膜下血肿3例患者的病例资料，评估其术前、术中可能存在的导致肾包膜下血肿发生的风险因素。结果：2例行双侧输尿管镜碎石术，1例行单侧输尿管镜碎石术，手术均顺利，但均发生肾包膜下血肿，其中1例术前并有高血压、糖尿病、尿路感染，发生双侧肾包膜下血肿并失血性休克；1例老年男性术前无其他并发症，术后术侧腰部出现皮下瘀斑，B超发现肾包膜下血肿；另1例术前并发高血压、糖尿病，行双侧输尿管镜碎石术，术后发生单侧肾包膜下血肿。结论：肾包膜下血肿是输尿管镜碎石术的一个严重并发症，高血压、糖尿病、高龄、尿路感染是其发生的危险因素，而手术本身导致的肾盂内压力改变是其发生的诱发因素。

Risk Factors Analysis of Renal Subcapsular Hematoma after Ureteroscopic Lithotripsy

Objective：To discuss the risk factors of renal subcapsular hematoma after ureteroseopic lithotripsy （USL） . Methods： Patients who received USL from June 2006 to December 2008 were retrospected, in which 3 patients who were complicated with renal subcapsular hematoma were analyzed for the risk factors of the complication which might exist before or in the operation. Results：The operation of the three patients was done successful- ly, of which two with bilateral USL and one with unilateral USL who were complicated with renal subcapsular hematoma. Case 1, a man who had hypertension, diabetes mellitus and urinary tract infection, developed with bilateral renal subcapsular hematoma and hemorrhagic shock. Case 2 ,an old man with no other observed disease presented with subcutaneous ecchymosis in the flank and renal subeapsular hematoma was detected by B ultrasound. Case 3, who had hypertension and diabetes mellitus, developed with unilateral renal subcapsular hematoma after bilateral USL. Conclusions：Renal subcapsular hematoma is a severe complication of USL. Hypertension, diabetes mellitus, eld and urinary tract infection are the main risk factors and the alteration of pressure in the renal pelvis resulted from operation is probably the causative factor of this complication.