微通道经皮肾镜取石术肾盂撕裂类型及防治

Classification,prevention and treatment of renal pelvis tear in microchannel percutaneous nephrolithotomy

目的总结微通道经皮肾镜取石术肾盂撕裂的类型,并探讨成因及防治对策。方法对2013年1月~2015年5月我科经治的10例微通道经皮肾镜取石术发生肾盂撕裂患者的临床资料进行回顾性分析。结果 3例患者发生肾外型肾盂撕裂,术中不能成功置入双J管,其中1例术后出现肾盂漏尿,肾周尿囊肿,发热等,予重置肾造瘘管,双J管及肾周引流管后好转;7例患者发生肾内型肾盂撕裂,无肾盂漏尿、感染发生。结论经皮肾镜取石手术肾盂撕裂可归纳为肾内型和肾外型,选择合理准确的经皮肾穿刺通道是预防肾盂撕裂的关键,针对不同的肾盂撕裂类型采取相应的治疗措施则是减轻患者不良预后的重要保障。

Objective To summarize the type of renal pelvis tear occurred in microchannel percutaneous nephrolithotomy,and to explore the prevention and treatment.Methods Clinical data of 10 cases of renal pelvis tear during microchannel percutaneous nephrolithotomy conducted during Jan.2013 and May 2015 were retrospectively reviewed.Results Of all cases,3 were extrarenal pelvis tear,and the placement of double-pigtail stent failed during the operation.Of the 3 cases,1 had urine leakage of renal pelvis,urinary cyst and fever after operation,and recovered after renal fistula and double-pigtail stent were placed.The other 7 cases were intrarenal pelvis tear without urine leakage of renal pelvis and urinary infection.Conclusions Two types of renal pelvis tear may occur in microchannel percutaneous nephrolithotomy：intrarenal and extrarenal.Choosing proper and accurate renal puncture channel is key to prevent such tears.Appropriate treatment tactics should be adopted to improve the prognosis.