经皮肾镜取石术并发脾脏损伤的诊治

Study on diagnosis and treatment of splenic injury during percutaneous nephrolithotomy

目的探讨经皮肾镜取石术(PCNL)并发脾脏损伤的临床特点及治疗方法。方法回顾性分析2012年4月收治的1例PCNL并发脾脏损伤的临床资料,并进行文献复习。患者,男性,38岁,因"左肾盂结石"行在B超定位下行"左侧微通道PCNL",患者在术中和术后均未见活动性出血,术后第2 d复查腹部平扫CT发现左肾造瘘管贯穿脾脏。予以卧床休息、密切观察和延长造瘘管的留置时间至术后2周。结果患者于术后第16 d康复出院。术后随访2个月,复查B超脾脏及肾脏均未见血肿形成。结论经皮肾镜取石术并发脾脏损伤较罕见,确诊主要依靠临床表现和相关影像学检查,卧床休息、延长肾造瘘管留置时间、经瘘道内注入止血剂、脾修补术和脾切除术作为可选的治疗方法。

Objective To evaluate the clinical characteristics and treatment of splenic injury after percutaneous nephrolithotomy （PC- NL）. Methods A 38 - year - old male patient with splenic injury after PCNL was reported. The calculi were in left renal pelvis and minimally in- vasive PCNL was performed under B - ultrasound monitoring. Active postoperative bleeding was not happened in this case. But a noncontrast CT scanning of his abdomen revealed that the nephrostomic tube was traversed through the spleen. Rest on bed, carefully monitoring and delayed re- moval of nephrostomic tube for 2 weeks were applied in this case. Results This patient had an uneventful recovery and no hematoma was found in kidney and spleen within the follow - up period of 2 months. Conclusion Splenic injury after PCNL is rare, but its diagnosis is properly based on clinical manifestations and imaging findings. Rest on bed, delayed removal of nephrostomic tube, deposition of hemostatic agents along the transs- plenic nephrostomic tract, splenorrhaphy and splenectomy were the options for treatment of splenic injury after PCNL.