微创经皮肾镜治疗上尿路结石的护理体会

目的:探讨微创经皮肾镜治疗上尿路结石的围手术期的护理特点。方法:我院2005年5月～2012年2月共235例患者行微创经皮肾镜治疗上尿路结石,在围手术期采取标准化的术前、术后护理及康复指导。结果:235例患者均康复出院。5例患者一次碎石不完全,二次微创经皮肾镜碎石。39例有结石残留,总结石取尽率为83.4%。18例患者有结石残留大于8 mm,经体外冲击波碎石排出。大出血病例共5例,4例经输血等保守治疗成功。术后1例大出血,介入止血成功。1例通道经过胸膜腔,术后拔除肾造瘘管出现胸痛等症状后发现,及时用凡士林纱布填塞瘘道吸收愈合。本组无腹腔脏器损伤等严重并发症。结论:加强术前术后护理观察,全面详细的健康指导,可提高微创经皮肾镜取石术治疗上尿路结石的成功率和减少并发症。

Nursing experience in patients with upper urinary tract calculi by minimally invasive percutaneous nephrolithotomy

Objective:To summarize the perioperative nursing experience in patients with upper urinary tract calculi undergoing minimally invasive percutaneous nephrolithotomy.Methods: Between May 2005 and Feb.2012,235 patients with upper urinary tract calculi were treated with minimally invasive percutaneous nephrolithotomy in our department and received standardized nursing measures and rehabilitation guidance.Results: The total 235 patients were recovered and discharged from hospital.Dissatisfactory outcome occurred in 5 patients,who were managed by secondary percutaneous nephrolithotomy.Postoperative stone residual was found in 39 cases,yet total stone clearance was 83.4%.Eighteen patients with residual stone larger than 8 mm were treated with extracorporeal shock wave lithotripsy(ESWL).Heavy bleeding occurred in 5 cases,4 were conservatively treated with blood transfusion and one with interventional embolizaiton.Intercostal approach was used in one case,who was complicated with chest pain after removal of the nephrostomy tube but managed with petrolatum gauze plugging.No serious complications such as abdominal organ injury occurred.Conclusion: Carefully planned perioperative nursing measures and full health guidance can boost successful percutaneous nephrolithotomy,yet reduce the complications in treatment of upper urinary tract calculi.