经皮肾手术肾造瘘管误入静脉系统的诊治分析  

Diagnosis and treatment of intravenous misplacement of the nephrostomy tube following percutaneous renal surgery

作　　者：陈晓峰[1] 邹义华[1] 邓旺龙[1] 许良余[1] 潘泽远 邓毕华[1] 周建军 Chen Xiaofeng;Zou Yihua;Deng Wanglong;Xu Liangyu;Pan Zeyuan;Deng Bihua;Zhou Jianjun(Department of Urology,the First People's Hospital of Chenzhou,Chenzhou 423000,China;Department of Urology,the Fourth People's Hospital of Chenzhou,Chenzhou 423000,China)

机构地区：[1]湖南省郴州市第一人民医院泌尿外科,郴州423000 [2]湖南省郴州市第四人民医院泌尿外科,郴州423000

出　　处：《中华泌尿外科杂志》2023年第1期47-51,共5页Chinese Journal of Urology

摘　　要：目的探讨经皮肾手术肾造瘘管误入静脉系统的诊治特点。方法回顾性分析2006年1月至2020年12月湖南省郴州市第一人民医院和湖南省郴州市第四人民医院共收治的6例肾造瘘管误入静脉系统患者的临床资料。男4例, 女2例;中位年龄41.0(38.5, 53.0)岁;有对侧上尿路手术史3例, 同侧上尿路手术史1例, 无上尿路手术史2例;孤立肾2例;铸形肾结石2例(合并轻度肾积水1例, 中度肾积水1例), 输尿管结石4例(合并轻度肾积水2例, 中度肾积水1例, 重度肾积水1例)。6例均行经皮肾镜取石术(PCNL), 术中在筋膜扩张器扩张后, 拔出扩张器内芯时血液由工作鞘涌出, 立即留置肾造瘘管并夹闭, 结束手术。5例术后返回病房后行CT检查明确诊断, 1例术中经肾造瘘管注入造影剂肾静脉显影, 早期明确诊断。6例中行左侧手术5例, 右侧1例;肾造瘘管末端位于同侧肾静脉内3例(均为行左侧手术), 经同侧肾静脉至下腔静脉2例(均为左侧手术), 经同侧肾静脉、下腔静脉至对侧肾静脉1例(行右侧手术)。6例均无合并肾静脉或下腔静脉血栓。监测患者生命体征, 严格卧床, 予抗感染治疗;保持造瘘管夹闭状态, 采用一步法(在超声监测下一次完全拔除肾造瘘管)或两步法(先在CT下监测下将肾造瘘管末端拔到肾窦内, 后在超声监测下将肾造瘘管完全拔除)拔除肾造瘘管。结果 1例肾造瘘末端位于同侧肾静脉者行一步法拔管;5例肾造瘘管末端位于同侧下腔静脉、对侧肾静脉或同侧肾静脉患者采用两步法拔管。6例拔管后生命体征稳定, 无经皮肾通道出血或血尿, 无肾周血肿, 无行开放手术者, 无肾静脉或下腔静脉血栓形成。5例按原计划PCNL方案进一步处理结石, 其中1例出院后1个月再次住院行PCNL, 4例住院期间行PCNL;1例未行PCNL,出院后1个月返院改行输尿管镜取石术。6例结石均取净, 顺利出院。结论造瘘管误入静�Objective To investigate the management of patients with intravenous misplacement of nephrostomy tube following percutaneous renal surgery.MethodsThe data of 6 patients with intravenous misplacement of nephrostomy tube during percutaneous nephrolithotomy(PCNL)treated in the two hospitals of Chenzhou from January 2006 to December 2020 were retrospectively analyzed.The median age was 41.0(38.5,53.0)years old.There were 4 males and 2 females.Three patients had undergone contralateral upper urinary tract operation.One patient had undergone ipsilateral upper urinary tract operation.Two patients had not undergone upper urinary tract operation.Two of the 6 patients had a solitary kidney.Two patients were diagnosed with staghorn calculi(combined with mild hydronephrosis in 1 patient,moderate hydronephrosis in 1 patient).Four patients were diagnosed with ureteral calculus(combined with mild hydronephrosis in 2 patients,moderate hydronephrosis in 1 patient,severe hydronephrosis in 1 patient).In all 6 patients,the tract was dilated with fascial dilators.Immediately after dilator removal,brisk venous bleeding was noted.A nephrostomy tube was inserted promptly through the sheath to tamponade the tract and was immediately closed.Five cases were diagnosed by CT after operation,and 1 case was early diagnosed by intraoperative injection of contrast medium through nephrostomy tube.The nephrostomy tube was misplaced in 5 patients with left upper urinary tract calculi,and in 1 patient with right upper urinary tract calculi.The tip of nephrostomy tube was located in ipsilateral renal vein in 3 patients with left upper urinary tract calculus,inferior vena cava in 2 patients with left upper urinary tract calculus,and contralateral renal vein in I patient with right upper urinary tract calculus.No venous thrombosis of renal vein or inferior vena cava was founded in the 6 patients.All 6 patients were managed with strict bed rest,intravenous antibiotics,and one-step or two-step tube withdrawal under close monitoring.One step method referr

关 键 词：肾结石 肾造瘘管 肾静脉 损伤 治疗 

分 类 号：R699.2[医药卫生—泌尿科学]