经皮肾穿刺造瘘管误入下腔静脉2例报道并文献复习  

Nephrostomy catheter following percutaneous nephrostolithotomy entering the inferior vena cava

作　　者：郭辉[1] 陈嵘[1] 杨冉星[1] 王营[1] 李鸿宾[1] 黄建文[1] 张炯[1] 傅强[1] GUO Hui;CHEN Rong;YANG Ranxing;WANG Ying;LI Hongbin;HUANG Jianwen;ZHANG Jiong;FU Qiang(Department of Urology,Shanghai Jiaotong University Affiliated Sixth People s Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属上海市第六人民医院泌尿外科,上海200233

出　　处：《现代泌尿外科杂志》2023年第3期238-241,共4页Journal of Modern Urology

摘　　要：目的探讨经皮肾穿刺造瘘管误入下腔静脉的发生原因以及处理体会。方法对2例超声引导下经皮肾穿刺造瘘管误入下腔静脉病例的治疗过程进行回顾性分析,探讨其发生原因、微创处理方式上的改变以及预防方案。结果2例患者均采用数字减影血管造影(DSA)下将肾造瘘管一步法一期回纳复位至肾盂集合系统。操作过程中患者未出现肾静脉的破裂出血,生命体征稳定。术后顺利拔除肾造瘘管。术后随访肾造瘘处伤口愈合良好,无肾周血肿等继发出血表现,预后良好。结论肾穿刺造瘘过程中肾造瘘管误入下腔静脉虽然少见,但后果严重,采用一步法一期回纳肾造瘘管能够有效安全地处理此类并发症。Objective To explore the causes and management of nephrostomy catheter following percutaneous nephrostolithotomy(PCNL)entering the inferior vena cava.Methods A retrospective analysis was performed on the management of two cases of nephrostomy catheter entering the inferior vena cava.The causes,changes of minimally invasive treatment and prevention plans were discussed.Results Two patients underwent digital subtraction angiography(DSA)to restore the nephrostomy tube to the renal pelvis collecting system.No renal vein rupture or bleeding occurred during the operation,and the patients vital signs were stable.Nephrostomy tube was removed successfully after operation.The wound healing was good,and there was no secondary hemorrhage such as perirenal hematoma.The prognosis was good.Conclusion Although intravenous nephrostomy tube misplacement is an uncommon PCNL complication,the consequences are serous.One-step retraction displacement of nephrostomy tube to the renal collecting system can effectively manage nephrostomy catheter entering the inferior vena cava.

关 键 词：经皮肾穿刺造瘘术 肾静脉 下腔静脉 医源性血管损伤 并发症 

分 类 号：R699.2[医药卫生—泌尿科学]