经皮肾镜碎石术后常见并发症分析及处理

The complications of percutaneous nephrolithotripsy and cured procedures

目的:探讨经皮肾镜碎石术(percutaneous nephrolithotripsy,PCNL)常见并发症处理及其防治措施。方法:回顾性分析2003年9月至2011年9月在我院行PCNL治疗的856例上尿路结石患者的临床资料,并对此手术的常见并发症和防治措施进行分析和讨论。结果:856例患者,共行987例次手术。并发术中出血27例,其中23例经处理出血停止,继续手术,4例活动性出血,予放置肾造瘘管,改行二期PCNL治疗,术后迟发性出血12例,其中6例经夹闭造瘘管,绝对卧床、输血及使用止血药后出血停止,3例经穿刺窦道Foleys管球囊压迫止血后成功止血,3例行介入治疗栓塞出血血管成功止血。术后出现高热、感染23例次(2.7%),其中包括2例感染性休克(0.23%)。术中发生胸膜损伤导致胸腔积液4例。8例术后肾造漏管口周围漏尿,经调整引流管深度及更换敷料等处理后好转。术后发生结石残留也比较常见,本组资料一期手术后结石残留率为15%(128/856),再次手术后为7.8%(67/856);总的结石取尽率为92.2%(789/856)。结论:术中、术后迟发性出血,术后感染是PCNL常见的并发症,而胸膜损伤、肾造漏管口周围漏尿也常常发生,应当予以重视。虽然PCNL术后仍可能存在结石残留问题,但它的微创和可重复取石的优点使其成为复杂性上尿路结石的首选治疗手段。

Objective ：To discuss the complications of percutaneous nephrolithotripsy （PCNL） and prevention and post treatment proce- dures. Methods： A retrospective analysis of clinical data from 856 patients who accepted PCNL during 2003.9 to 2011.9 ,was made along with a discussion of the complications and treatment procedures. Results： There were 856 patients who had 987 operations,27 patients had bleeding in the operation and 23 of them continued with the operation. Four patients had active bleeding,requiring the placement of a nephrostomy tube for the secondary operation. There were 12 patients with imngfire hemorrhage after operation. Six were cured by clipping the nephrostomy tube ,bed rest, blood transfusion, and injected hemostatics. Three were cured by placing Foley＇s balloon catheters in si- nus. Three were cured by vascular embolotherapy. Twenty^three patients had fever and infection （2.7%） ,including two septic shock. Four patients had pleural effusion because violations of the pleura. Four patients had leaking urine around nephrostomy tube. This was cured by an adjusting the depth of the draft tube and dressing changes The other complications were residual atones, In our data, the re- maining rate of one-stage operation was 15% （128/856）. The rate of secondary operation was 7.8% （67/856） ,and the total eliminating rate was 92. 2% （789/856）. Conclusion： The commonest complicationto PCNL is intraoperative and postoperative bleeding and postoper- ative infection, but the violation of the pleura and leaking urine around the nephrostomy tube often happens Therefore, emphasis is needed for postoperative care. Though residual atones can be a problem of PCNL,it is a first choice for complex upper urinary stones because of the minimally invasive and repeatable lithotripsy.