经皮肾镜碎石术并发肝脏损伤11例诊治分析

Diagnosis and treatment of 11 cases of liver injury due to percutaneous nephrolithotripsy

目的 探讨经皮肾镜碎石术(PCNL)并发肝脏损伤的诊断及处理方法,以期为同类患者的诊治提供经验。方法 检索2017年10月—2022年10月在广西中医药大学附属瑞康医院接受PCNL的926例患者,收集并分析合并肝脏损伤患者的诊疗过程。结果 11例患者并发肝脏穿刺损伤,其中男性6例,女性5例,平均年龄(55.00±13.25)岁,损伤均由术后复查电子计算机断层扫描(CT)确诊。术后血红蛋白平均下降(14.00±11.97)g/L,1例患者因脓肾及多次手术需接受输血治疗,全部患者通过延长拔除肾造瘘管时间[平均(6.73±1.27)d]后均痊愈出院。结论 在无明显腹膜炎体征及血流动力学稳定的前提下,PCNL并发肝脏损伤时保守处理通常是安全且有效的。

Objective To explore the diagnosis and management of liver injury caused by percutaneous nephrolithotripsy(PCNL),so as to provide reference for the diagnoise and treatment of similar patients.Methods The clinical data of 926 patients who underwent PCNL during Oct.2017 and Oct.2022 were searched,and the data of those complicated with liver injury were analyzed.Results A total of 11 cases were collected,including 6 males and 5 females,average age(55.00±13.25)years.All injuries were confirmed with CT.The average decrease of hemoglobin after operation was(14.00±11.97)g/L.One patient needed blood transfusion due to pyonephrosis and multiple operations,and all patients were cured and discharged after delaying the removal of nephrostomy tube [an average of(6.73±1.27)days].Conclusion In the absence of obvious signs of peritonitis and hemodynamic stability,conservative treatment of liver injury caused by PCNL is safe and effective.