经皮肾镜取石术少见并发症9例分析

Analysis of the Rare Complications of Percutaneous Nephrolithotomy

目的:探讨经皮肾镜取石术(PCNL)的安全性、少见并发症及处理。方法:回顾性分析笔者所在医院接受PCNL治疗的658例患者临床资料,发生少见手术并发症9例,记录其术前并存疾病、术前准备、麻醉方式和并发症处理,并作系统分析。结果:9例均发生于该术式开展总数不足200例以内;盲目穿刺2例,"C"臂介导4例,B超引导3例;大出血选择性肾动脉栓塞4例,十二指肠损伤中转修补1例,14F硅胶肾造瘘管经肾静脉分支进入下腔静脉安全退出1例,输尿管撕脱伤中转开放1例,感染性休克1例,死亡1例;经积极治疗8例好转出院。结论:PCNL在设备、整体技术条件不够成熟和开展初期风险仍较高;病例选择、术者技能、三维空间认识和操作规范与少、罕见并发症的发生密切相关,成熟的动脉数字显影技术、跨科合作有利于并发症的治疗和该技术的拓展。

Objective： To explore the safety and analyze the rare complications and management after percutaneous nephrohthotomy.Method： 658 patients with renal calculi had undergone the percutaneous nephrohthotomy, the clinical data of 9 patients with rare comphcations were analyzed retrospectively, to recorde the features of preoperative preparation, preoperative preparation, means of anesthesia and the management of comphcations.Result： 9 patients with rare comphcations cccurred in the initial stage of 200 cases （2 cases with blind puncture , 4 cases under the guide of C Ann X Ray Machine, 3 cases under the guide of type-B ultrasonic）; 4 cases with gross hemorrhage underwent the selective renal arteriography, 1 case with duodenal trauma underwent the neoplasty, 1 case with F14 nephrostomy tube into the inferior vena cava by error, 1 case with ureral awlsion injury, 1 case of septic shock, 1 case died, the rest 8 patients left hospital successfully.Conclusion： The risk of PCNL is comparative high in the initial stage with equipment, and the overall technical condition is not mature enough.Patient selection, the surgeon＇s skill, cognition of the surgical three-dimensional space are closely related to the occurrence ofrare comphcations, the mature arterial digital imaging technology, cmss-departrnent cooperation are favorable to the management ofthe comphcations.