经皮肾穿刺造瘘术的并发症及防治措施

Percutaneous Nephrostomy:Complications and Treatments

目的探讨经皮肾穿刺造瘘及双J管置入术并发症产生原因及防治措施。方法回顾性总结2007年1月至2008年4月,采用超声联合C臂血管机透视导向,对247例肾积水患者行经皮肾穿刺造瘘术,部分病例术中置入双J管,分析相关并发症的发病情况及其防治措施。结果本组247例肾积水患者,均在超声联合C臂血管机透视导向下完成穿刺置管术,成功率100%;严重并发症发生率为4例(1.6%),其中3例术后发生严重出血,1例术中发生感染性休克,无周围脏器损伤及死亡病例;轻度并发症共25例(10%),包括血尿、尿路感染、穿刺部位血肿、肾周血肿、引流管脱出梗阻、内双J管梗阻移位等。结论熟悉肾造瘘和输尿管内双J管置入术的操作程序,术前综合评估并发症产生的危险因素,并积极防范处理,可有效提高手术安全性和治疗效果。

Objective To analyze the complications of percutaneous nephrostomy and antegrade ureteral Double-J cathater insertion. Materials and Methods 247 cases treated with percutaneous nephrostomy guided by Ultrosound and C-arm mobile fluroscopy were retrospectively investigated from January 2007 to April 2008 and the causes of complications and suitable treatments were analyzed. Results All cases were done under ultrasound and C-ann mobile fluoroscopy guided. The successive rate is 100%. Severe complications（1.6%） occurred in four cases, including 3 severe hemorrea and one sepsis to shock. The minor complications（25 cases, 10%）were hematuria, urinary tract infection, local haematoma, perirenal haematoma, drainage tube obstruction and exodus, inner double-J tube displace and obstruction. Conclusion Percutaneous nephrostomy guided by Ultrasound and C-arm mobile fluoroscopy is a safe procedure and preoperative analyzing the high risk factors of complications and preparing the preservation methods may sublimate the security and therapeutic efficacy.