经皮肾镜取石术致胸腔积液的病例特点  

Clinical Characteristics of Pleural Effusion Caused by Percutaneous Nephrolithotomy

作　　者：赵亚兵 何文强 王光策[1] 陈铸[1] 何伟 ZHAO Yabing;HE Wenqiang;WANG Guangce;CHEN Zhu;HE Wei(Department of Urology,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院泌尿外科,河南郑州450000

出　　处：《河南医学研究》2021年第15期2721-2724,共4页Henan Medical Research

基　　金：河南省重点研发与推广专项(科技攻关)(182102310059)。

摘　　要：目的总结经皮肾镜取石术(PCNL)致胸腔积液的病例特点。方法回顾分析河南中医药大学第一附属医院泌尿外科2017年7月至2020年1月PCNL术致胸腔积液患者的临床资料,总结其诊断及治疗方法。结果241例接受PCNL术治疗的患者中,共7例(2.9%)出现胸腔积液,其中男3例,女4例,平均年龄48岁。7例患者均因铸型肾结石接受PCNL术治疗,其中3例为多通道取石,4例为单通道取石,采用第11肋下做穿刺点5例,第12肋下穿刺点2例。3例于术中出现气道压增高,查X线示胸腔积液;2例术后第1天呼吸困难,经皮动脉血氧饱和度(SpO_(2))下降,背部疼痛,胸部不适。5例均经胸片及B超检查证实为患侧胸腔积液,无并发气胸,均行胸腔闭式引流。2例术后无明显症状,术后胸部CT复查时发现患侧胸腔积液,未特殊处理。结论经皮肾镜手术后可能出现胸腔积液,术中及术后应密切观察呼吸系统体征,出现症状应行CT或X检查,必要时行胸腔闭式引流。Objective To summarize the clinical characteristics of pleural effusion caused by percutaneous nephrolithotomy.Methods The clinical data of patients with pleural effusion caused by PCNL in the Department of Urology,the First Affiliated Hospital of Henan University of Chinese Medicine from July 2017 to January 2020 were retrospectively analyzed,and the diagnosis and treatment methods were summarized.Results Of the 241 cases,7 cases(2.9%)developed pleural effusion,including 3 males and 4 females,with an average age of 48 years.All 7 cases received PCNL due to cast kidney stones(3 cases had multi-channel stone removal,4 cases had single channel,5 cases used the 11th subcostal puncture point,and 2 cases used the 12th subcostal puncture point).Three cases showed increased airway pressure during the operation,and X-ray showed pleural effusion.Two cases showed dyspnea,decreased percutaneous arterial oxygen saturation(SpO_(2)),back pain and chest discomfort on the first day after the operation.Five cases were confirmed as fluid chest on the affected side without complicated pneumothorax by chest radiograph and B-ultrasound examination,and closed thoracic drainage was performed.Two patients had no obvious symptoms after surgery,but pleural effusion on the affected side was found in postoperative chest CT reexamination,without special treatment.Conclusion Pleural effusion may occur after percutaneous nephrolithotomy.Respiratory signs should be closely observed during and after surgery,and CT or X examination should be performed if symptoms appear.Close thoracic drainage should be performed if necessary.

关 键 词：皮肾镜取石术 胸腔积液 胸腔闭式引流 

分 类 号：R692.4[医药卫生—泌尿科学]