微通道经皮肾镜取石术中胸腹腔积液的诊断和处理

Diagnosis and treatment of pleural effusion and ascites during micro-channel percutaneous nephrolithotomy

目的:探讨微通道经皮肾镜取石术治疗肾结石术中并发胸腹腔积液的诊断和处理方法。方法:2008年至2013年间320例肾结石患者接受微通道经皮肾镜取石,对其中10例并发胸腹腔积液的患者资料作回顾性分析。结果:本组男性8例,女性2例,平均年龄39.5岁,左侧肾结石7例,右侧3例,在B超定位下经第11肋间或12肋骨下穿刺,术中发现6例轻度胸腹腔积液,2例出现严重的胸腹腔积液,术后发现2例轻度胸腹腔积液,分别经胸腔引流和腹腔引流、保守治疗后治愈;微通道经皮肾镜取石术治疗肾结石术中并发胸腹腔积液发生率为3.1%(10/320),9例随访3月无异常发现。结论:微通道经皮肾镜取石术治疗肾结石术中可并发胸腹腔积液,严重的胸腹腔积液须立刻引流;术中仔细观察、减低灌注液压力、减少胸腹膜损伤等是防止胸腹腔积液的关键。

Objective： To explore the diagnosis and treatment of pleural effusion and ascites caused by microchannel percutaneous nephrolithotomy in the treatment of renal calculi. Methods： 320 cases of renal calculi from 2008to 2013 underwent micro-channel percutaneous nephrolithotomy. Among them, 10 cases were complicated by pleural effusion and ascites. The clinical data were retrospectively analyzed. Results： The group included 8 male and 2 female,with average age 39.5 years;left renal caculi in 7 cases, right renal caculi in 3 cases. They were punctured under B ultrasound localization through the eleventh intercostal or under 12 rib. In the operation, 6 cases were found of mild pleural effusion. and 2 cases of severe pleural effusion and ascites. After the operation 2 cases of mild pleural effusion and ascites were found. They were cured by chest and abdominal cavity drainage and conservative treatment. 9 patients were followed-up without abnormality in three months. Conclusion： Micro-channel percutaneous nephrolithotomy in the treatment of renal calculi can be complicated by pleural effusion and ascites. Severe pleural effusion and ascites should be drained immediately careful. Intraoperative observation, reduce of the perfusion fluid pressure, decrease of pleural and peritoneal injury are the keys to prevent pleural effusion and ascites.