Massive Hemoperitoneum Secondary to Splenic LacerationAfter Extracorporeal Shockwave Lithotripsy
体外冲击波碎石术 (ESWL) 被认为是一种安全的技术,但并非没有并发症,尽管绝大多数是轻微的并发症。这里描述了 ESWL 后罕见的脾损伤病例。
一例 33 岁的男性在经历了严重的间歇性左侧腰痛三周后就诊于急诊室 (ED),此前有一次机动车事故造成的外伤史。计算机断层扫描 (CT) 显示左侧肾结石。 ESWL 在三周后进行。出院回家后,他在同一天返回急诊室,腹痛持续恶化,低血压和多次晕厥。 CT 显示可能是由于活动性出血导致的脾脏主动对比剂外渗的存在。最初的复苏是静脉输液和血液制品。第二天,完成了脾动脉的栓塞。经过 9 天的保守治疗,患者出院回家。一个月后,他因大量左侧胸腔积液而出现呼吸急促,并通过胸腔穿刺术和胸腔镜手术治疗。随后的随访显示了许多改进和成功的保守管理。 脾损伤是 ESWL 的一种罕见并发症,文献中报道的所有 11 例病例均采用脾切除术治疗。此案例在成功地进行保守管理方面是独一无二的。
Introduction
一例 33 岁男性,47 天前曾有一次车祸 (MVA) ,既往有吉尔伯特综合征和慢性轻度血小板减少症病史,在经历严重间歇性左侧腰痛三周后,到急诊室 (ED) )就诊 。计算机断层扫描 (CT) 显示 9 毫米左中极肾结石。三周后行,ESWL 在全身麻醉(丙泊酚 150 毫克、芬太尼 100 微克、罗库溴铵 50 毫克、气管插管和间歇正压通气)下三周后进行。总共进行 2500 次冲击,每分钟 60 次,功率从 1 到 7 mAmp。在前 100 次电击后进行 3 分钟的暂停。在透视后成像上有很好的结石分散。手术顺利进行,患者随后在同一天出院回家,情况稳定。同一天晚上,他因持续的、恶化的腹痛、低血压和多次晕厥就诊。CT显示腹腔积血、脾周大血肿(图(图1)、1),以及可能由于活动性出血导致的脾脏主动对比剂外渗(图(图2))。立即管理包括静脉输液(乳酸林格氏液 75 毫升/小时)、两个单位的浓缩红细胞 (RBC)、两个单位的血小板、两个单位的新鲜冰冻血浆 (FFP) 和氨甲环酸剂量(1000 毫克)。ED 和外科重症监护室 (SICU)。第二天早上,患者在监护下的麻醉护理 (MAC) 下接受了介入放射学 (IR) 手术以进行脾栓塞。然后,在他住院期间继续保守治疗。9 天后,他出院回家,血流动力学稳定。严格指导患者三个月内避免参加接触性运动、摔跤、山地自行车、滑雪、跳伞、军事格斗、剧烈活动。
Figure 1
腹部 CT 显示脾周血肿(白色箭头)和腹腔积血(黑色箭头)。
Figure 2
CT显示从脾后部(箭头)延伸的线性高密度与可能由于活动性出血引起的活动性外渗相一致。
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