浅析输尿管镜手术并发症分析与防治

Brief analysis and prevention and treatment of complications in ureteroscope operation

目的分析讨论输尿管镜手术的并发症以及其防治措施。方法回顾性分析160例行输尿管镜手术患者的临床资料,总结分析术中以及术后发生并发症的原因及处理措施。结果术中发生并发症:输尿管穿孔2例(1.25%);术后发生并发症:肉眼血尿20例(12.50%),结石残留8例(5.00%),发热4例(2.50%),腰痛6例(3.75%),双J管移位2例(1.25%)。2例输尿管穿孔患者因穿孔较小,双J管越过穿孔位置后停止手术,4周后再次行输尿管镜术碎石成功;术后20例患者出现肉眼血尿,使用止血药物后,肉眼血尿均在3 d内消失;结石残留患者在术后2周行体外冲击波碎石术,随访2个月,8例患者均排石成功;术后4例患者出现发热,给以抗生素加强抗感染治疗,4例患者均在5 d内好转,体温达到正常;6例患者出现腰痛,对腰痛患者行腹部平片检查,4例患者因结石残留引发腰痛,体外冲击波碎石后疼痛缓解,2例患者因双J管扭曲发生疼痛,拔出双J管后疼痛缓解;2例患者发生双J管移位,经输尿管镜取出。结论输尿管镜手术所引发的并发症与医生的操作技术、术中灌注压的大小、双J管的应用以及输尿管的条件有关,熟练的技术以及充分认识各种并发症发生的原因可预防并发症的发生。

Objective To analyze and discuss complications in ureteroscope operation and their prevention and treatment measures. Methods Clinical data of 160 patients receiving ureteroscope operation were retrospectively analyzed. Causes and management measures for intraoperative and postoperative complications were summarized and analyzed. Results Intraoperative complications included 2 cases with ureteral perforation（1.25%）. Postoperative complications included 20 cases with gross hematuria（12.50%）, 8 cases with residual calculi（5.00%）, 4 cases with fever（2.50%）, 6 cases with osphyalgia（3.75%） and 2 cases with double J ureteral catheter shifting（1.25%）. Due to small ureteral perforation in 2 cases, their operation ceased after double J ureteral catheter through perforation, followed by successful ureteroscope lithotripsy after 4 weeks. 20 cases with gross hematuria received hemostatics and had disappeared gross hematuria within 3 d. Patients with residual calculi received extracorporeal shock wave lithotripsy after 2 weeks, and 2-month follow-up showed successful lithagogue in 8 cases. 4 cases with fever received enhanced anti-infection treatment by antibiotics, and all 4 cases showed improvement and normal temperature within 5 d. Abdominal plain film examination in 6 cases with osphyalgia showed 4 cases with residual calculi-induced osphyalgia, who were relieved by extracorporeal shock wave lithotripsy, and 2 cases with double J ureteral catheter shifting-induced osphyalgia, who were relieved by double J ureteral catheter removing. Double J ureteral catheters shifting in 2 cases were removed through ureteroscope. Conclusion Complications in ureteroscope operation are related with doctor＇s operation technique, intraoperative perfusion pressure, double J ureteral catheter and ureteral catheter condition. Practiced technique and full understanding of complication causes can prevent complications.