微创经皮肾造瘘输尿管镜钬激光碎石术并发症的预防及处理

The prevention and management of complications of mini-invasive percutaneous nephrolithotomy with holmium:Yttrium-aluminum-garnet laser

目的探讨微创经皮肾造瘘输尿管镜取石术(MPCNL)治疗上尿路结石中出现的并发症及相应处理。方法回顾性分析接受MPCNL治疗194例复杂性上尿路结石患者的临床资料,总结出现的并发症,采取的治疗方法及转归。结果首次手术后结石总体清除率为78.8%(153/194),其中单纯肾盂结石和输尿管上段经石清除率为89%(150/168)。急性肺水肿1例,水中毒(容量负荷增加)发生率32%(63/194),手术时间超过1.5小时发生率明显增加。输尿管支架管不到位3例,术后脱落入膀胱3例,术后复查并及时拔除双J管。肾周血肿1例,3个月后腹腔镜开窗引流术,肾周水肿3例。心肺功能障碍1例,及时心肺复苏好转。术后全身炎性反应综合征发生率8.9%,积极抗炎后好转。结论提高手术技能、选取合适适应证、及时发现病情变化有助于减少并发症,当并发症不可避免时,应及时处理,必要时行手术防止症状进一步恶化。

Objective To investigate the complications and treatments in using Mini-percutaneous nephrolithotomy （MPCNL） with holmium： Yttrium-aluminum-garnet laser. Methods 194 patients of calculus of upper urinary track were treated with MPCNL in total. The complications of operation and their turnover after treatments were reviewed retrospectively. Results The rate of stone-free cases after fist treatment was 153 （78.8%）, and that of renal pelvis stones coexisting without calcic stones and upper ureter stone was 150 （89%）. 1 case had pulmonary edema and the rates of cardiovascular changes was 32%. When the operation time was over 1.5 hours, the overhydration rates were dramatically increased. 6 cases had mal-positioned ureter stents. 1 case had perirenal hematoma and 3 cases had perirenal dropsy. 1 case for cardiovascular and respiratory dysfunction, cardiopulmonary resuscitation succeeded. About 8.9% of the patients developed systemic inflammatory response syndrome （ SIRS）, and it has been cured after future antibiotics. Conclusion Improving of operation skills, good indications and preoperative preparation will decrease complications of MPCNL.