降低超声引导下经皮肾镜取石术并发症方法的探讨  

Discussion on the reduction of the complications in ultrasound-guided percutaneous nephrolithotomy

作　　者：周帆[1] 杨为民[2] 严春晖[1] 刘锋[1] 骆雨[1] 

机构地区：[1]解放军第161医院泌尿外科,武汉430010 [2]华中科技大学同济医学院附属同济医院泌尿外科

出　　处：《临床泌尿外科杂志》2014年第9期803-805,共3页Journal of Clinical Urology

摘　　要：目的：探讨降低超声引导下经皮肾镜取石术（PCNL）治疗肾结石及输尿管上段结石并发症的方法。方法：回顾性分析我院2010年1月~2013年12月接受超声引导下经皮肾镜取石术患者的临床资料：术中出血2例,术后出血9例,持续发热9例,胸膜损伤2例。术中出血者放置肾造瘘管并夹闭肾造瘘管,立即终止手术;术后出血者经调整肾造瘘管位置后缓解;持续发热者通过尿培养及药敏试验结果选择敏感抗生素后缓解;胸膜损伤者因气胸肺压缩较少,胸腔积液较少,保守治疗后恢复。结果：11例出血者术后3个月复查肾脏CT,肾脏结构完整,肾周无明显积液及血肿等。9例持续发热者1周后复查血常规、尿常规均正常。2例胸膜损伤者术后3个月复查X线胸片正常。结论：超声引导下经皮肾镜取石术是一种安全、有效的手术方式,加强术前准备、术中操作及术后管理的相关环节,能有效降低出血、感染及胸膜损伤等手术并发症,有利于本手术更好地使用。Objective：To discuss the methods of reduction the complications in ultrasound-guided percutaneous nephrolithotomy （PCNL） for renal and upper ureteral calculi. Method：We retrospectively analyzed the clinical data of ultrasound-guided PCNL from 2010 January to 2013 December. The data were as follows： intraoperative hemorrhage was found in two cases; nine cases experienced postoperative bleeding; nine cases suffered from persistent fever; two cases experienced pleural damage. For two cases of intraoperative hemorrhage, we immediately terminated the operation after placing and clipping renal fistula. For nine cases with postoperative bleeding, we adjusted the renal fistula location and resulted in controlling the bleeding. By urine culture, drug susceptibility test we chose the sensitive antibiotics and had good prognosis in nine cases with persistent fever. Conservative treatment for two cases with pleural damage had good recovery due to less pneumothorax lung compression and pleural effu- sion. Result： CT examination showed 11 cases of intra or post-operative bleeding recovered kidney structural integ- rity without obvious effusion and hematoma. Blood and urine examination were performed after a week in nine ca- ses with persistent fever, and results were normal. X-ray chest radiography examinations were performed after three months in two cases of pleural damage, and no abnormal signs were found. Conclusion： Ultrasound-guided PCNL is a safe, effective operation. Strengthening the preoperative preparation, intra or post-operative management can effectively reduce the complications of bleeding, infection, injury of pleura and others. PCNL will be conducted better under ultrasound-guidance.

关 键 词：经皮肾镜取石术 出血 感染 胸膜损伤 

分 类 号：R699.2[医药卫生—泌尿科学]