经皮肾镜碎石术冲洗液外渗并发多脏器功能障碍临床诊治分析

Multiple organ dysfunction syndrome after percutaneous nephrolithotomy induced by extravasation of irrigant fluid

目的 总结经皮肾镜碎石（PCNL）术中冲洗液外渗并发多脏器功能障碍综合征（MODS）的诊断及治疗方法.方法 报道本院2例患者PCNL术后发生MODS诊治经过.例1术中肾盂黏膜穿孔大量冲洗液外渗,术后继发MODS,经切开引流、输蛋白利尿等方法处理后好转.例2因术中冲洗液外渗,出血性休克继发MODS,经DSA栓塞、连续性肾脏替代治疗（CRRT）、抗感染治疗后好转.结果 2例患者MODS均控制,重要脏器功能基本恢复.结论 术中干预可以防止PCNL术中冲洗液外渗MODS的发生,术后早期采取综合治疗措施可以促进重要脏器恢复.

Objectives To discuss the diagnosis and management of Multiple organ dysfunction syndrome MODS after the percutaneous nephrolithotomy（PCNL）.Methods TWO cases with MODS after PCNL were reviewed.Case 1 was a man patient with staghorn calculi.After PCNL massive extravasation of irrigant fluid caused severe metabolic acidosis,and then it worsened to MODS,By sufficient drainage and using relative drugs the patient recovery quickly.Case 2 was a women patient.A massive haemorrage occurred after the PCNL.And acute hemorrhagic shock and severe sepsis happened,which brought her to MODS.Using DSA thrombosis of renal artery and continu-ous renal replacement therapy,the woman also recovered from the disease.Results The secondary MODS after PCNL was well controlled and nobody died.Conclusions The two cases gave us a lesson that we should take more attention while patients presented relative symptom.Then,the efficient intervention can be implemented.