上尿路结石患者行ESWL治疗后并发症及预防措施

The complications and preventive measures after treatment of ESWL in patients with upper urinary calculi

目的探讨体外冲击波碎石(ESWL)治疗上尿路结石后的并发症和应采取的预防措施。方法选取我院自2014年9月~2016年10月泌尿科收治进行ESWL治疗的患者500例,对术后产生的并发症采取相应的处理措施,并根据有无并发症分为观察组(并发症组)与对照组(无并发症组),比较两组患者观察指标的差异;进一步将观察组患者分成血尿组、尿路感染组、血尿合并尿路感染组,分别与对照组比较观察指标差异。总结出预防ESWL术后并发症的最佳预防措施。结果 500例患者的体外碎石有效率为94.8%;387例患者治疗后出现血尿、肾绞痛、皮肤出血、石街、尿路感染和肾包膜下血肿六种并发症,并发症比率从高到低不等。观察组、血尿组、尿路感染组、血尿合并尿路感染组在结石冲击次数、能量、长度及宽度方面明显高于对照组(P<0.05)。结论掌握ESWL治疗的并发症发生原因,针对每种并发症采取最佳的预防措施,可以减少或避免并发症的发生,以增强疗效。

Objective To explore the complications and the preventive measures to be taken after the treatment of up- per urinary calculi with extracorporeal shock wave lithotripsy（ESWL）. Methods 500 patients treated with ESWL in our hospital from September 2014 to October 2016 were enrolled. The corresponding measures were taken to deal with the complications after surgery. The patients were divided into observation group （complication group） and control group （noncomplication group）, and the differences in observation indexes were compared between the two groups. The patients in the observation group were divided into hematuria group,urinary tract infection group and hematuria combined with urinary tract infection group,and the difference in observation indexes of the above groups were compared with the those of control group respectively. And the best preventive measures to prevent postoperative complications of ESWL were summarized. Results The effective rate of extracorporeal lithotripsy was 94.8% in 500 patients. Six kinds of com- plications including hematuria,renal colic,skin bleeding,stone street,urinary tract infection and renal subcapsular hematoma occurred in 387 patients. With complication rate ranging from high to low（P〈0.05）. The number of stone shocks,energy,length and width in the observation group,hematuria group, urinary tract infection group and hematuria combined with urinary tract infection group were higher than those in the control group（P〈0.05）. Conclusion Mastering the causes of complications of ESWL treatment and taking the best precautions for each complication can reduce or avoid the occurrence of complications and enhance the curative effect.