B超引导下微通道经皮肾镜取石术并发症探析.doc

B超引导下微通道经皮肾镜取石术并发症分析 　　[摘要]目的 探讨B超引导下微通道经皮肾镜取石术（mPCNL）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mPCNL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mPCNL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 [关键词]微通道经皮肾镜取石术；并发症；治疗 [中图分类号] R692.4 [文献标识码] A [文章编号] 1674-4721（2016）09（a）-0069-03 Clinical analysis and treatment of complications of B ultrasound-guided micro channel percutaneous nephrolithotripsy HUANG Xiao-long LIU Hai-hua Department of Urology Surgery，People′s Hospital of Shayang County in Hubei Province，Shayang 448200，China [Abstract]Objective To evaluate the occurrence and management of complications following B ultrasound-guided micro channel percutaneous nephrolithotripsy（mPCNL）.Methods From June 2012 to Augest 2015，167 cases of B ultrasound-guided mPCNL were performed for upper urinary tract stones in our department.The surgical complications and treatment methods were analyzed.Results Among the 167 cases of mPCNL，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 in 2 cases （1.2%） post-mPCNL，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 mPCNL has the advantages of convenient operation，less complications.T