微创手术治疗泌尿系结石合并血液学异常的围手术期处理

Perioperative treatment of minimally invasive surgery of urinary tract calculi accompany with hematological abnormalities

目的探讨微创手术治疗泌尿系结石并血液学异常围手术期处理的经验。方法对泌尿系结石有微创手术指征并血液学异常的36例患者围手术期的处理作回顾性分析。结果 36例患者中选择适当微创手术方式,除3例肾多发性结石有少量残留结石外,其余均一次清除结石。29例肾功能衰竭患者取石后,血肌酐改善或恢复正常;血红蛋白、中性粒细胞计数、血小板计数与术前变化不大。全组未发生严重出血、感染、急性溶血。术后病程7～11 d,平均9 d。结论加强泌尿系结石并血液学异常患者的围手术期处理,可以减少微创手术取石术中、术后并发症,缩短住院时间。

Objective Urinary tract calculi is the most common disease,the endoscopic surgery can release most of the obstruction recently,but the patient accompanies with hematological abnormalities who is more problematic to receive surgery.The aim of this study was to the perioperative treatment of minimally invasive surgery of urinary calculi accompany with hematological abnormalities.Methods From October 2000 to December 2009,36 cases of urinary tract calculi accompanied with hematological abnormalities who received minimally invasive surgery were analyzed retrospectively.25 male and 11 female patients with the mean age of 36.2 years old（range：23-56） were accompanied with hematological abnormalities like mediterranean anemia,autoimmune hemolytic,idiopathic thrombocytopenic purpura,etc.Results 3 cases with multiple renal stones remain residual calculus after minimally invasive surgery,the rest 33 cases reached one phrase stone free status,serum creatinine level improved or return to normal in 29 cases of renal failure after the releasing of obstruction,postoperative hemoglobin,neutrophilic leukocyte counts,platelets counts had no significant change comparing with each case preoperatively,there were no severe hemorrhage,infection and acute haematolysis occurred perioperatively,the mean hospital stay after surgerywas 9 days postoperatively（range 7 to 11 days）.Conclusion To pay attention to the perioperative treatment of urinary tract calculi accompany with hematological abnormalities can reduce the perioperative complications and shorten the hospital stay.