经皮肾镜碎石术治疗1584例肾和输尿管结石患者的并发症及处理  

Complications of 1 584 cases of renal and ureteral calculi treated by percutaneous nephrolithotripsy and the managements

作　　者：龙清志[1] 李翔[1] 贺大林[1] 陈兴发[1] 王新阳[1] 樊荣[1] 张露[1] 何辉[1] 

机构地区：[1]西安交通大学第一附属医院泌尿外科,陕西西安710061

出　　处：《现代泌尿外科杂志》2016年第7期516-519,共4页Journal of Modern Urology

摘　　要：目的总结1 584例行经皮肾镜碎石术的肾和输尿管结石患者的并发症和处理方法。方法从2006年6月到2015年6月,对我院连续收住的1 584例肾和输尿管结石患者,术前采用B超、尿路平片、静脉尿路造影、CT、ECT、尿培养等检查评估结石及肾功能情况。采用Olympus输尿管镜或Wolf肾镜,对所有患者行经皮肾镜碎石术(PCNL),记录患者并发症及处理方法。结果定义结石碎片<4mm为结石清除,在1 584例肾和输尿管结石患者中,一次治疗结石清除1 450例(91.5%),结石残留134例(8.5%)。术中取好俯卧位后出现血压、心率下降11例;一次通道建立失败103例;严重肾出血24例,术中16例、术后迟发性出血8例。肾脏穿孔17例。气胸3例,胸腔积液8例。无肝脏、脾脏、结肠损伤发生。发热298例,尿路感热48例,尿脓毒症8例。所有并发症均进行相应处理。结论经皮肾镜碎石术治疗肾和输尿管结石效果理想。但该手术存在一定的并发症,甚至有些会造成严重后果,了解这些并发症有助于泌尿外科医生安全实施这种手术。Objective To explore the complications and managements of renal and ureteral calculi treated by percutaneous lithotripsy（PCNL）.Methods A total of 1 584 cases of renal and ureteral calculi hospitalized during June 2006 and June2015 were collected.All patients received ultrasound,KUB,intravenous urography,CT,ECT and urine culture.PCNL was conducted with Olympuss semirigid ureterorenoscopy or Wolfs nephroscopy.The complications and managements were recorded.Results Stone-free was defined when the fragments were less than4 mm.Of all cases,1 450（91.5%）were stone-free with one procedure,and134（8.5%）had residual stones.Blood pressure and heart rate decreased after prone position in11 cases.The access failed in103 cases.Serious renal hemorrhage occurred in24 cases,16 during operation,and8 after operation.Kidney perforation occurred in 17 cases.Pneumothorax occurred in3 cases.Hydrothorax occurred in8 cases.No liver,spleen or colon injury was observed.A total of 298 patients developed fever,48 cases were urinary tract infection and 8 were sepsis.All complications were treated with auxiliary methods.Conclusions PCNL is effective and safe to treat renal and ureteral calculi.However,complications may occur and some may even cause serious consequences.It is helpful to perform PCNL more carefully if urologists understand those complications and the managements.

关 键 词：肾和输尿管结石 经皮肾镜碎石术 并发症 

分 类 号：R69[医药卫生—泌尿科学]