经皮肾镜取石术中肾静脉损伤的处理经验探讨(附2例报告)  

Management of renal vein injury during percutaneous nephrostolithotomy:an experience with 2 cases

作　　者：黄云腾[1] 顾思平[2] 齐隽[1] 游志远[2] 周晓明[2] 

机构地区：[1]上海交通大学医学院附属新华医院泌尿外科,上海200092 [2]福建省石狮市医院微创外科,石狮350007

出　　处：《第二军医大学学报》2012年第6期673-675,共3页Academic Journal of Second Military Medical University

摘　　要：目的总结经皮肾镜取石术中肾静脉损伤的原因及其对策。方法回顾性分析2007至2008年间行经皮肾镜取石术患者中,共发生肾静脉损伤2例,均为男性,年龄分别为61岁和41岁;均因左肾结石行经皮肾镜取石术,术中发生斑马导丝穿入左肾静脉,肾造瘘管沿导丝误入左肾静脉及腔静脉,术后经肾造瘘管造影、螺旋CT检查明确。41岁的患者术后第7天在X线监视下将肾造瘘管退至集合系统,术后第10天拔除。61岁患者术后第14天在X线监视下将肾造瘘管退至肾集合系统,术后第18天拔除。结果两例患者拔除肾造瘘管后,出血均得到控制,血液动力学状态稳定,未发生肾静脉瘘口出血,未行外科手术干预,未出现肾脏感染及肾功能进一步损害。结论经皮肾镜取石术中发生肾造瘘管误入肾静脉后,采用留置并夹闭肾造瘘管,分次逐步拔除肾造瘘管是安全、可靠的,可以避免外科手术干预。Objective To discuss the reasons and management of renal vein injury during percutaneous nephrostolithotomy（PCNL）.Methods From 2007 to 2008 renal vein injury was caused in two patients by malposition of nephrostomic catheter in our hospital.The two patients were both males,aged 61 years old and 41 years old.They underwent PCNL due to left kidney stones.The percutaneous nephrostomy（PCN） catheters were malpositioned into the left kidney vein and vena cava,which was confirmed by prograde radiography and spiral CT scan after operation.The PCN catheter in the 41 years old patient was pulled back to renal collecting system on the 7th day,and was extracted on the 10th day under X-ray monitoring.The PCN catheter in the 61 years old patient was pulled back to the renal collecting system on the 14th day and was extracted on the 18th day under X-ray monitoring.Results The bleeding was controlled and the hemodynamic status was stable in the two cases after removal of PCN catheters.There was no renal arteriovenous fistula bleeding,surgical intervention,kidney infections or further damage of kidney function.Conclusion Renal vein injury during the PCNL can be managed by clamping the PCN catheter and gradual withdrawal.The method is safe and reliable,and it can avoid surgical intervention.

关 键 词：经皮肾镜取石术 经皮肾造瘘术 肾静脉 损伤 肾造瘘管 

分 类 号：R692.4[医药卫生—泌尿科学]