B超引导下微通道经皮肾镜取石术并发症分析

Clinical analysis and treatment of complications of B ultrasound-guided micro channel percutaneous nephrolithotripsy

目的探讨B超引导下微通道经皮肾镜取石术（m PCNL）治疗上尿路结石的手术并发症及处理方法。方法回顾性分析2012年6月~2015年8月在我院行B超引导下m PCNL术治疗的167例上尿路结石患者的临床资料,分析其手术并发症及处理方法。结果 167例患者中出现并发症33例（19.8%）,包括Peel-away鞘置入失败2例（1.2%）,其中1例通过调整完成手术,1例改二期手术;术后发热25例（15.0%）,其中发生感染性休克1例（0.6%）,经积极抗感染、抗休克等治疗后痊愈;术中严重出血需输血者3例（1.8%）,经夹闭肾造瘘管等方法止血痊愈;术后迟发性出血2例（1.2%）,行高选择性肾动脉栓塞术成功止血;胸膜损伤1例（0.6%）,经保守治疗痊愈;无结肠、肝、脾等腹腔内脏器损伤发生。结论 B超引导下m PCNL具有操作便捷、手术并发症少等优点。及时、正确处理手术并发症是提高手术安全性的关键。

Objective To evaluate the occurrence and management of complications following B ultrasound-guided micro channel percutaneous nephrolithotripsy（m PCNL）.Methods From June 2012 to Augest 2015,167 cases of B ultrasound-guided m PCNL were performed for upper urinary tract stones in our department.The surgical complications and treatment methods were analyzed.Results Among the 167 cases of m PCNL,a total of 33（19.8%） patients encountered complications.Of these cases,Peel-away sheath placement failure occurred in 2 cases（1.2%）,in which 1 case needed secondary surgery.25 cases of postoperative fever（15.0%）,septic shock occurred in 1 case（0.6%）.The 1 septic shock patient was cured after active anti-infection and anti-shock treatment.3 cases were treated with blood transfussions due to severe hemorrhaging（1.8%）,the clipping hemostasis nephrostomy method recovery.There was extensive hemorrhage in2 cases（1.2%） post-m PCNL,super-selecive renal artery embolisation was performed in 2 cases.Pleural injury in 1 case（0.6%）,which were cured with conservative therapy.There were no case of abdominal organ injury.Conclusion B ultrasound-guided m PCNL has the advantages of convenient operation,less complications.Timely,correctly handle the operation complications is the key to enhance the operation safety.