微创经皮肾镜取石术手术并发症分析  

Analysis of complications of minimally invasive percutaneous nephrostolithotomy

作　　者：刘忠泽[1] 李世俊[1] 张福庆[1] 苏运强[1] 吴宪伟[1] 薛健[1] 朱勇[1] 杨春生[1] 姜文弟 肖汝涛[2] 崔金花[2] 季洁明 

机构地区：[1]北京仁和医院泌尿科,102600 [2]北京仁和医院超声科,102600

出　　处：《中华泌尿外科杂志》2006年第7期447-449,共3页Chinese Journal of Urology

摘　　要：目的探讨微创经皮肾镜取石术(MPCNL)并发症的发生情况及处理措施。方法2001年12月至2005年3月实施MPCNL436例次。男249例次,女187例次。患者年龄14～71岁,平均42岁。其中单纯肾结石314例次,肾结石合并输尿管上段结石79例次,单侧输尿管上段结石27例次,双侧输尿管上段结石16例次。结果436例次手术出现并发症27例次(6.2%),其中大出血5例,通过关闭肾造瘘口、拔血器清除膀胱内血块、输血等措施治愈；胸腔积液2例,腹腔积液11例,肾贯通伤8例,通过穿刺引流治愈；术后肾盏积脓1例,选择有效抗生素、再次肾穿刺并延期拔出肾造瘘管治愈。结论MPCNL为微创手术,但在技术不熟练情况下,风险仍较大,加强并发症的防治有利于此项技术的开展。Objective To evaluate the occurrence and management of complications following minimally invasive percutaneous nephrostolithotomy （MPCNL）. Methods The data of 436 cases of MPCNL from December 2001 to March 2005 were reviewed, including 249 male cases and 187 female cases. Their age ranged from 14 to 71 years with a mean of 41.6 years. Of the 436 cases,314 cases had simple nephrolithiasis ,79 had nephrolithiasis combined with upper ureterolithiasis ,27 had unilateral upper ureterolithiasis,and 16 had bilateral upper ureterolithiasis. Results Among the 436 cases of MPCNL,complications occurred in 27 cases （6.2%）. Of the 27 cases,5 had massive hemorrhage, which was cured by closing meatus of nephric fistula,cleaning out the blood clot within the bladder with instrument and transfusing blood;2 cases had pleural effusion, 11 cases had hydroperitoneum, 8 cases had renal perforating injury, and they were cured by puncture and drainage; 1 case had pyocallx, which was cured by using effective antibiotics,re-puncturing kidney and postponing pulling out the fistula catheter. Conclusions MPCNL is a minimally invasive operation. However,it has obvious risk if the surgeong skill is not proficient. The improvement in the prevention and management of complications can promote the application of this procedure.

关 键 词：微创经皮肾镜取石术 并发症 预防 

分 类 号：R699[医药卫生—泌尿科学]