微创经皮肾镜取石术治疗上尿路结石并发症及其对策研究.docVIP

微创经皮肾镜取石术治疗上尿路结石并发症及其对策研究 　　 作者单位：425006 湖南省永州市人民医院 　　通讯作者：蒋磊 　　【摘要】 目的 探讨微创经皮肾镜取石术（MPCNL）治疗上尿路结石的手术并发症及其防治对策。方法 回顾性分析2008年4月～2010年6月本院应用MPCNL治疗上尿路结石312例的临床资料，对手术并发症和防治措施进行分析和探讨。结果 312例患者，共行341例次手术，术中、术后共发生并发症71例次，其中胸膜损伤、气胸2例次；术中大出血3例次；未能成功留置双J管5例次；术后高热、感染56例次；术后肾造漏管脱落3例次；术后迟发大出血1例次；尿外渗1例。经采取相应措施均治愈。无腹腔脏器损伤。结论 术中术后大出血、术后感染、气胸、尿外渗等是MPCNL较严重而常见的并发症，开展MPCNL时加强并发症的防治至关重要。 　　【关键词】 输尿管结石； 肾结石； 经皮肾镜碎石术； 并发症 　　The reseach on the countermeasure and the treatment of upper urinary calculi by the way of minimally invasive percutaneous nephrolithotomy JIANG Lei,ZENG Chun-ming.Yongzhou Peoples Hospital,Yongzhou 425006,China 　　【Abstract】 Objective To explore the countermeasure and the treatment of upper urinary calculi by the way of minimally invasive percutaneous nephrolithotomy（MPCNL）.Methods Retrospective analysis of the clinical data of 312 patients who were treated the upper urinary calculi by the way of MPCNL from June 2008 to April 2010 was conducted as well as the complications of surgery and prevention measures.Results 312 patients were conducted 341 surgeries.71 cases of the intraoperative and postoperative complications occured, including pleural damage,2 cases of pneumothorax,and three cases of hemorrhea,fail encumbrance of jtube 5 times,56 cases of infection and hyperpyrexia,a heavy bleeding after a long time and urinous infiltration.Taking appropriate measures,all were healed without abdominal organs damage.Conclusion Intraoperative and postoperative bleeding, postoperative infection, pncumothorax and urious infiltration were serious and common complications when MPCNL was conducted,so it was vital to prevent the complications. 　　【Key words】 Ureteral calculus; Renal calculus; MPCNL; Complication 　　 微创经皮肾镜取石术（MPCNL）是治疗上尿路结石的有效手段，因其损伤小，取石率高，可重复取石，并发症发生率较传统经皮肾镜明显降低而成为治疗上尿路结石的首选方法之一［1,2］。但MPCNL也会不可避免地出现感染、出血、损伤邻近组织器官等并发症，对其并发症的积极预防、早期发现及妥善处置十分重要。笔者所在医院自2008年4月～2010年6月开展MPCNL治疗上尿路结石341例次，发生并发症71例次。现报告如下。 　　1 资料与方法 　　1.1 一般资料 本组患者312例，男188例，女124例，年龄26～73岁，平均51.8