180例经皮肾微造瘘输尿管镜取石术治疗的并发症及治疗

Experience of complication management of minimally-access percutaneous nephrolithotomy

目的:探讨经皮肾微造瘘输尿管镜取石术(MPCNL)的并发症及防治方法。方法:回顾性分析本中心2008年10月～2010年10月MPCNL治疗的180例患者临床资料,总结相关的手术并发症。结果:本组患者Ⅰ期MPCNL术后出现残留结石70例(38.8%),发生并发症47例(26.1%),其中肾皮质裂伤4例(2.2%),肾盏颈部撕裂伤2例(1.1%),肾小动脉(Ⅱ、Ⅲ级分支)裂伤5例(2.8%),肾动脉静瘘1例(0.5%),输尿管支架管放置不佳10例(5.5%),肾造瘘管脱出1例(0.5%),液气胸2例(1.1%),术后感染22例(12.2%),均治愈出院。结论:手术适应证的掌握、术者经验的积累和充分的术前准备,均有助于减少MPCNL治疗上尿路结石相关并发症的发生。

Objective：To investigate the complications of minimally-access percutaneous nephrolithotomy （MPCNL） and the experience of management. Methods： From october 2008 to october 2010, we retrospective analysis 180 patients who underwent Mini-PCNL, sum up the complications related to the operation. Results： Among the 180 cases of mini-PCNL, the patients of initial residual-stones were 70 cases （38.8%）, complications occurred in 47 cases. 4 cases （2.2%）had renal cortical laceration, 2 cases （1. 1% ）had the neck of calix laceration,5 cases （2.8%） occurred enal arterial laceration, one case （0. 5% ）occurred renal arteriovenous fistula,the position of stents tubes in 10 cases（5.5% ）were inappropriate, one case （0.5%） dropped out the nephrostomy tube,2 cases （ 1.1% ） were liquid pneumothorax,22 cases （ 12.2% ） had postoperative infection, no case had colon perforation, All the patients were cured and discharged. Conclusions： Master the operation indication, accumulate experience of operation, afford sufficient preoperative preparation, All helps to reduce the related complications of Mini-PCNL in in treating with upper-urinary calculus.