经皮肾镜取石术并发症的分析及处理

目的探讨经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)并发症及处理方法。方法回顾性分析2006年2月~2009年月10月410例PCNL中35例发生并发症的临床资料,其中大出血10例(其中迟发2例),肾集合系统穿孔9例,术后高热、感染12例,体液大量外渗与吸收致休克4例。结果 10例大出血中,开放手术1例,介入手术2例,7例保守治疗。肾盂穿孔,感染,体液大量外渗致休克患者行保守治疗。35例均治愈出院,无一例死亡。32例随访3~6个月,2例行超选择性肾动脉栓塞者显示术侧部分肾功能丧失,其余患者分肾功能均正常。结论 PCNL可发生大出血、肾集合系统穿孔、术后感染、体液大量外渗与吸收等并发症,规范操作,术中、术后密切观察可能发生的并发症,及时处理才能提高PCNL疗效。

Analysis and Management of Complications of Percutaneous Nephrolithotomy

Objective To investigate the complications of percutaneous nephrolithotomy（PCNL） and their managements.Methods Clinical data of 410 cases of PCNL that were performed during February 2006 to October 2009 was studied retrospectively.Serious complications were noted in 35 patients with an incidence rate of 8.5%.Among the 35 cases,10 patients developed massive hemorrhage,9 patients had renal pelvic perforation,12 patients had infection and 4 patients experienced shock because of massive liquid absorption. Results Among the ten cases of massive hemorrhage,one patient received operation,two patients underwent interventional therapy,and seven were treated with conservative management.The patients with infection or shock were all treated by conservative management.All the 35 patients were cured.The 32 survived patients were followed up for 3 to 6 months,2 of the patients who received superselective arterial embolization were detected with partial renal dysfunction during the follow-up;while the other 30 patients showed normal renal function. Conclusions Complications of PCNL include massive hemorrhage,perforative pelvis,postoperative infection,and massive liquid absorption.Close monitor before and after the operation is the key to the procedure.