4例腔镜下钬激光治疗上尿路结石手术失败原因分析及其预防措施  

Endoscope-guided holmium laser lithotripsy for upper urinary tract calculi:Analysis of complications and failure

作　　者：马宏青[1] 程文[1] 高建平[1] 张征宇[1] 葛京平[1] 周文泉[1] 周水根[1] 魏武[1] 位志峰[1] 徐晓峰[1] 徐锋[1] 解鹏[1] 

机构地区：[1]南京军区南京总医院泌尿外科,南京210002

出　　处：《医学研究生学报》2010年第8期852-855,共4页Journal of Medical Postgraduates

基　　金：江苏省"六大人才"高峰重点资助项目(2005A2)

摘　　要：目的随着腔镜技术在上尿路结石治疗中的广泛应用,术中与术后大出血、严重感染、休克甚至死亡的病例也时有发生。为寻求和积累腔镜下钬激光治疗上尿路结石的经验,进一步提高治愈率。方法回顾自开展钬激光碎石以来发生4例严重并发症病例的诊治过程,并结合相关文献讨论腔镜下钬激光治疗上尿路结石失败原因及其对策。结果4例严重的并发症分别为2例肾破裂致大出血,1例严重感染、休克及播散性血管内凝血(disseminated intravascular coagulation,DIC)致死亡及1例输尿管镜术后出血并感染。结论腔镜下钬激光治疗上尿路结石失败的主要原因包括:①组织结构的变异、结石、炎症等;②其他因素给手术带来的困难;③没有进行严格的病例选择;④术者临床经验不足。故术前应充分考虑影响上尿路腔镜下钬激光治疗结石的不利因素,掌握其手术的适应证及并发症,并拟出相应对策,以提高其治愈率。Objective With the endoscope technique in the treatment of urinary tract stones,postoperative bleeding,severe infection,shock and even cases also occure.This study aimed to sum up the experience in the endoscope-guided holmium laser lithotripsy for the treatment of upper urinary tract calculi so as to raise the cure rate of the disease.Methods We retrospectively analyzed 4 cases of upper urinary tract calculi that developed serious complications after treated by endoscope-guided holmium laser lithotripsy,reviewed the related literature and investigated the causes of failure and effective countermeasures.Results The serious complications included 2 cases of renal rupture-induced hemorrhage,1 case of death due to severe infection,shock and disseminated intravascular coagulation,and 1 case of post-ureteroscopy bleeding and infection.Conclusion The main causes of failure in the endoscope-guided holmium laser lithotripsy included： ① morphological variation,calculus and inflammation;② other factor-induced difficulties in surgery;③ neglect of strict selection of cases;④ lack of clinical experience.Adequate consideration should be given preoperatively to various unfavorable factors influencing endoscope-guided holmium laser lithotripsy for upper urinary tract calculi,its indications and complications,and corresponding countermeasures.

关 键 词：钬激光技术 尿结石 经皮肾镜碎石术 输尿管镜 

分 类 号：R691.4[医药卫生—泌尿科学]