ESWL术治疗肾结石术后并发症原因分析及防治措施

The Causal Analysis and Prevention Measures of ESWL Treatment of Kidney Stones Postoperative Complications

目的分析体外冲击波碎石术(ESWL)治疗肾结石术后并发症发生原因及防治措施。方法 对638例肾结石患者行B超定位下低能量ESWL治疗,冲击能量8～10 kv,冲击次数1 000～3 000次,平均冲击次数2 020次。结果 肾上中盏结石276例,粉碎率为98.8%,3个月内结石排净率为89.7%;肾下盏结石85例,粉碎率97.8%,3个月内结石排净率83.3%;肾盂结石277例,粉碎率为98.6%,3个月内结石排净率95.3%。术后共有36例(5.6%)出现并发症,包括严重血尿4例,发热5例,肾绞痛12例,肾包膜下血肿5例,石街形成10例。结论 ESWL治疗肾结石具有定位准确、操作简便、成功率高等优点。但要掌握好适应症,使用合适的能量冲击,控制冲击碎石的次数以及做好必要的术前准备工作,便可以有效地减少或避免并发症的发生。

Objective To analyze the causes and put forward prevention measures of the extracorporeal shock wave lithotripsy （ESWL） treatment of kidney stones postoperative complications. Methods 638 patients with kidney stones got the treatment of ESWL by B - uhrasonography under low - energy with 8 - 10kv impact energy and 1 000 -3 000 impact times. The impact times averaged 2 020. Results The number of upper calyx and kidney light stones was 276 and the smashing rate was 98. 8%. The stone clearance rate was 89. 7% in three months. The number of calyceal stones was 85 and the smashing rate was 97. 8%. The stone clearance rate was 83.3% in three months. The number of pelvic stones was 277 and the smashing rate was 99. 4%. The stone clearance rate was 95.3% in three months. There were 35 complications, in- cluding 4 cases of severe hematuria, 5 eases of fever, 12 eases of renal colic, 5 cases of renal subcapsular hematoma and 10 cases of stone formation. Conclusion ESWL treatment of kidney stone has the advantages of accurate positioning, easy opera- tion and high success rate. However, we should master the indications, use the appropriate impact energy, control the impact times and make the necessary preoperative preparation. In this way, the complications can be effectively reduced or avoided.