体外冲击波碎石术后严重并发症的处理方法  

Treatment of severe post-ESWL complications

作　　者：周骏[1] 梁朝朝[1] 叶元平[1] 刘明[1] 施浩强[1] 郝宗耀[1] 张贤生[1] 樊松[1] 

机构地区：[1]安徽医科大学第一附属医院泌尿外科,合肥230022

出　　处：《中华泌尿外科杂志》2014年第9期691-694,共4页Chinese Journal of Urology

基　　金：国家临床重点专科建设项目

摘　　要：目的 探讨体外冲击波碎石术（ESWL）后严重并发症的处理方法. 方法 回顾性分析2008年1月至2013年6月收治的21例ESWL术后严重并发症患者的临床资料,男10例,女11例.年龄34～71岁,平均47岁.21例曾行ESWL治疗1～21次,平均3次.肾脏ESWL 14例,输尿管ESWL 7例,其中双侧同时行ESWL 1例.14例伴有发热,体温最高42.1℃.尿常规：WBC（＋～＋＋＋）,血常规：WBC 10.5～ 23.4× 106/L.6例SCr 230～1 110 μmol/L.21例均行B超、KUB和泌尿系CT平扫检查,5例行增强扫描.临床诊断为肾包膜下血肿3例,尿外渗伴腹膜后感染6例,肾积脓5例,急性肾功能不全6例,肾萎缩1例. 结果 3例肾包膜下出血经保守治疗3个月后血肿吸收.6例尿外渗伴腹膜后感染中,2例经留置双J管及抗感染治疗1周后体温及血象正常,症状消失,4例肾周脓肿患者经切开引流治疗后,脓腔消失,体温及血象正常.5例肾积脓中4例行输尿管镜手术或肾穿刺,解除梗阻后,症状缓解,1例重度积水肾功能丧失行肾切除术.6例肾功能不全行输尿管镜手术或逆行置双J管治疗后,4例肾功能恢复正常,2例处于氮质血症期.1例肾萎缩,肾功能丧失行肾切除术. 结论 ESWL引起的严重并发症可导致严重后果,明确诊断后应积极采取有效的措施进行处理.Objective To study the treatment and prevention of severe complications after extracorporeal shock-wave lithotripsy （ESWL）.Methods We retrospectively analyzed the clinical data of 21 cases with severe complications after ESWL,including 10 males and 11 females,with average age of 47 （34-71） years.All 21 cases underwent ESWL,with average of 3（1-21） times.7 cases had calculi in ureter and 14 had calculi in kidney.1 case was treated bilaterally.14 cases had fever and the highest temperature was 42.1 ℃.Urinalysis of 21 cases was found abnormal and white blood cell showed positive（＋-＋＋＋）.Complete blood count also appeared abnormal and white blood cell exceeded normal range from 10.5 to 23.4× 106/L.SCr of 6 cases were abnormal fromn 230 to 1 110 μmol/L.All the cases were checked with ultrasound,KUB and CT scan,included 5 cases underwent enhanced CT scan.The severe complications post-ESWL were listed as following：3 renal subcapsular hematoma,6 urinary extravasation with retroperitoneal infection,5 pyelonephritis,6 acute renal failure and 1 renal atrophy after operation.All patients were treated properly according to the respective condition.Results 3 renal subcapsular hematoma had absorbed by non-surgical treatment after 3 months.In 6 cases with urinary extravasation with retroperitoneal infection,2 were recovered by placing double J stents and antibiotics after 1 week.4 cases with renal abscess were healed with incision and drainage operation.In 5 cases with pyelonephritis,symptoms of 4 cases relieved by ureteroscopic operation or nephrostomy.1 case underwent nephrectomy due to severe hydronephrosis and empyemata.6 cases with actute renal failure were relieved by ureteroscopic operation or placing double J stents.2 cases with acute renal failure were caught in SCr levels of compensation stage.The others 4 were recovered completely.1 case underwent nephrectomy due to renal atrophy and loss of function.Conclusions The severe complications post-ESWL are common to seen in clinical practice,but

关 键 词：体外冲击波碎石术 并发症 外科治疗 

分 类 号：R699[医药卫生—泌尿科学]