输尿管硬镜相关肾损伤三例报告及经验总结

Three Cases of Rigid Ureteroscopy Related Renal Injury:Case Reports and Experiencens Summary

目的探讨输尿管硬镜相关肾损伤的临床特点、发生机制、治疗措施及预防措施。方法对638例输尿管硬镜手术后发生肾损伤的3例的临床资料进行回顾性分析。结果 3例均因输尿管结石伴或不伴肾积水就诊并行经尿道输尿管硬镜手术,术后24 h内均出现不同程度患侧肾区疼痛,1例经输尿管和膀胱X线(KUB)检查及腹部CT检查发现DJ管位置异常提示肾盂穿孔,1例腹部CT检查提示肾脏自发性破裂出血,1例腹部CT及超声引导下穿刺证实为肾实质脓肿。此3例经对症治疗后均病情好转。结论输尿管硬镜相关肾损伤是输尿管硬镜手术罕见并发症,但后果严重。对输尿管硬镜手术患者术前仔细评估高危因素、术中采取预防措施,可减少相关肾损伤的发生。

Objective To investigate the clinical features,mechanism,management and preventive measures of rigid ureteroscopy related renal injury.Methods A retrospective analysis was performed on 3 of 638 patients with renal injury after rigid ureteroscopy between 2010 and 2018.Results All 3 patients underwent rigid transurethral ureteroscopy for ureteral calculi with or without hydronephrosis,and they suffered different degrees of renal pain in 24 h postoperatively.Perforation of the renal pelvis was confirmed in one case by KUB and abdominal CT for abnormal position of DJ catheter,spontaneous rupture of the kidney confirmed in one case by CT scan,and renal parenchymal abscess was confirmed in one case by abdominal CT and percutaneous ultrasound-guided renal puncture.All 3 patients recovered after different symptomatic treatment was administrated respectively.Conclusion Rigid ureteroscopy related renal injury is a rare complication with serious consequences.Comprehensive assessment of risk factors preoperatively and preventive measures intraoperatively should be taken to reduce the occurrence of renal injury.