经皮肾镜取石术危重并发症的临床救治  

Clinical treatment of serve complications of PCNL

作　　者：包娟 郑奇传 徐伟 蒋堃 叶扬 陈翔 

机构地区：[1]安徽省马鞍山市立医疗集团人民医院泌尿外科,243000

出　　处：《中华全科医学》2014年第7期1066-1067,1070,共3页Chinese Journal of General Practice

摘　　要：目的 对经皮肾镜取石术（PCNL）后发生的危及患者生命的并发症原因进行分析总结,探讨PCNL危重并发症的围手术期预防和处理措施。方法 回顾性分析医院2010年10月—2012年9月开展经皮肾镜取石技术的病例,探寻危重并发症的主要病因和病理基础、总结预防、诊治及抢救措施。结果 本组共完成37例,其中男性24例,女性13例;平均年龄（50±1）岁。肾结石30例,肾结石合并输尿管上段结石7例,曾有患侧肾脏手术史3例。发生危重并发症4例,发生率为10.8%。分别为迟发性肾出血致失血性休克1例;灌注液吸收伴发急性呼吸窘迫综合症1例、肾集合系统损伤,尿外渗致腹膜后巨大积液,诱发麻痹性肠梗阻、体循环衰竭1例;脓毒症引起全身炎症反应综合征1例。平均手术时间80min（20～180min）,危重并发症病例平均手术时间138min（90～180min）。4例患者分别经重症监护抢救、抗休克、抗感染、加强支持等治疗,病情痊愈,无死亡病例。结论 经皮肾镜碎石术是一种安全有效的治疗上尿路结石方法之一,但同时存在一定的手术风险。PCNL术后危重并发症特点是发病急,病情凶险,若未及时有效的诊治,极有丧失患者生命的可能。遵循手术适应症,充分术前准备,术中规范治疗,控制手术时间,减少灌注液吸收,是预防PCNL严重并发症发生的关键。术后严密观察病情变化,及时处理并发症是挽救患者生命的有效措施。Objective To search the major causes of PCNL＇s complications,which threaten the patients＇ lives,and to investigate the prevention and treatment measures of these complications. Methods Review and analyze the cases of PCNL operation in our Hospital which had severe complications to search major causes since July 2010 and explore the measures of prevention and emergency treatment. Results As results,our team had conducted 37 cases in total which had 24 male and 13 female patients. The average age was 50. In addition,30 patients had renal calculus,7 of them had upper ureteral calculi,and 3 of them had experienced side kidney operation. In our research,10. 8% PCNL operations had severe complications. The major causes which lead to such complications were hemorrhage,the absorption of the perfusion fluid,urinary extravasation and sepsis. All the four patients in the case were cured by intensive care,counter shock and supporting Therapy. Conclusion The PCNL operation can lead to complications which threaten patients＇ lives. In order to prevent those serious complications,this article suggested that in practice doctors should,firstly,follow the operation indication and contraindication. Then,adequate preparation pre-operation,normative treatments during the operation,and close observation of patients＇ condition post-operation were the keys.

关 键 词：经皮肾镜取石术 危重并发症 病因 

分 类 号：R692.4[医药卫生—泌尿科学] R699.2[医药卫生—外科学]