微通道经皮肾镜取石手术并发症的治疗体会

Experience of complication management of mini-percutaneous nephrolithotomy

目的探讨微通道经皮肾镜取石术并发症的原因和处理方法。方法回顾性分析675例行微通道经皮肾镜取石患者中44例有并发症者的病因和处理方法,其中出血而需进一步处理者17例,穿刺通道丢失11例,十二指肠损伤1例,肾盂穿孔伤4例,肾盂输尿管连接部狭窄2例,感染8例,脑血管意外1例。结果出血者分别用局部压迫、选择性肾动脉栓塞等处理治愈;穿刺通道丢失者再建通道;十二指肠损伤1例,及时局部引流,肠外营养治愈;肾盂穿孔伤4例,依穿孔大小、位置和结石大小选择不同手术时机再次手术;肾盂输尿管连接部狭窄2例,分别行腔内和开放手术治愈;感染8例,局部引流,选择敏感抗生素控制感染后再次手术;脑血管意外1例。44例出现并发者42例治愈,再次微通道经皮肾镜取石术效果满意。结论微通道经皮肾镜取石术疗效好,并发症少,只要积极预防和及时处理并发症,仍可治愈结石。

Objective To probe the causes and treatment of complications of the mini-percutaneous nephrolithotomy （mini-PCNL）. Methods The causes, prevention and treatment of 44 cases with complications in the 675 cases who underwent mini-PCNL were analyzed. Among the 44 cases, 17 developed bleeding, 11 lost the tract of puncture, 4 had renal pelvic perforation, 1 duodenum perforation, 2 stricture of the ureteroplevic junction, 8 infection and 1 cerebrovascular accident. Results The bleeding was cured by local pressure, angiography or renal artery embolization. The lost tract of puncture was rebuilt. The renal pelvic perforation received operation according to size and position of the perforation, and size of the stone. The duodenum perforation was cured by timely local drainage and the parenteral nutrition. Stricture of the ureteroplevic junction received intercavity cure or open operation. The infection was cured by local drainage and sensitive antibiotics. The cerebrovascular accident didn＇t receive further treatment. Of the 44 cases, the calculus of 42 had been cured by mini-PCNL. Conclusion It was suggested that mini-PCNL had satisfactory effect and lower rate of complication. If the complications were prevented actively and treated timely, the calculus could be removed.