體外震波碎石術後所造成腎臟血腫之相關分析

蔡正晏、王又德、蕭博任、張議徽、陳冠亨、連啟舜、謝博帆、邱鴻傑、鄒頡龍、陳國樑

葉進仲、陳汶吉、張士三、黃志平、張兆祥、楊啟瑞、吳錫金

中國醫藥大學附設醫院 泌尿部

Analysis of Renal Hematoma after Extracorporeal Shock Wave Lithotripsy.

Cheng-Yen Tsai, Yu-De Wang, Po-Jen Hsiao, Yi-Huei Chang, Guan-Heng Chen, Chi-Shun Lien, Po-Fan Hsieh, Hung-chieh Chiu, Chieh-Lung Chou, Kuo-Liang Chen, Chin-Chung Yeh, Wen-Chi Chen, Shih-San Chang, Chi-Ping Huang, Chao-Hsiang Chang, Chi-Rei Yang, Hsi-Chin Wu   

Divisions of Urology, China Medical University Hospital, Taichung, Taiwan

Introduction: We aim to evaluate the risk factors, clinical manifestation, and the outcome of renal function for renal hematoma following ESWL in a single-center clinical setting.

Methods: A retrospective analysis was made of 39 post-ESWL renal hematoma cases diagnosed between Feb. 2014 and March 2022. We performed lithotripsy therapy with intravenous general anesthesia by the Lithotripter (Dornier MedTech Compact Delta). We analyze factors from the past history, blood analysis, computed tomography (CT), treatment for the hematoma, and the following renal function. 

Results: In our study, thirty-eight patients (97.4%) presented with moderate to severe flank pain as the commonest symptom. Most of them suffered from gross hematuria or microscopic hematuria (86.8%). Twenty-nine patients in the group (74.4%) were overweight (BMI > 24) and the average BMI was 26.4. Twenty-three patients (58.9%) with hypertension. There were only 2 patients (5.1%) with coagulopathy and 6 patients (15.79%) had taken aspirin previously. Twenty-four (61.5%) of the whole group were left renal stones and twenty stones (51.3%) were located at the middle pole. Most of them received conservative treatment, 36.8% received blood transfusion and 26.3% underwent transarterial embolization due to contrast media extravasation noted by the CT image. Five patients (12.8%) drop their Hb level by more than 35%. The acute effects of ESWL in the kidney with 14 patients (35.9%) decreased GFR up to 30% but only two patients (5.1%) documented the chronic effect after one year of follow up.