微通道经皮肾镜碎石术后并发感染性休克1例报告并文献复习

Septic Shock Following Mini-percutaneous Nephrolithotomy: a Case Report and Review of Literatures

本文报道1例59岁右肾结石合并轻度积水女性患者,术前尿培养结果阳性,给予抗感染治疗后,行右侧微通道经皮肾镜碎石术(minimally invasive percutaneous nephrolithotomy,MPCNL),术中过程顺利,术后出现感染性休克表现:开始表现血氧饱和度低,不能脱离呼吸机,术后6 h出现血压下降,给予去甲肾上腺素泵入,更换抗生素,持续呼吸机辅助呼吸等治疗后患者治愈出院。我们认为对于结石较大、复杂,预计手术时间长的患者,尽量避免选用微通道;处理MPCNL术后并发感染性休克,重症监护、抗感染科、泌尿外科在内的多学科协作是必要的。

[Summary] A 59-year-old woman was reported with calculi in both kidneys and mild hydronephrosis in the right kidney . Bacterial culture was positive from urine samples .After she was given antibiotics therapy , a mini-percutaneous nephrolithotomy was performed.The operation time was 100 min.Septic shock developed after the procedure , manifested as hypotension at 6 hours after surgery, low oxygen saturation , and needing mechanical ventilation . After norepinephrine administration , sensitive antibiotic treatment, and mechanical ventilation , the patient＇s condition was markedly improved and discharged . In conclusion, mini-percutaneous nephrolithotomy should be avoided in patients with large and complex stones or long operation time expectation .In case of septic shock , it is necessary for intensive care and multidisciplinary collaboration including urology and anti -infectious diseases .