微创经皮肾造瘘输尿管镜取石术的并发症及处理

目的：探讨微创经皮肾输尿管镜碎石术（MPCNL）治疗复杂性上尿路结石中产生并发症的种类、原因及相应处理方法。方法：回顾性分析接受MPCNL治疗的246例复杂性上尿路结石患者的临床资料，记录所有产生的并发症及其相关处理和转归情况并进行分析。结果：共有84例（34．15％）患者术后存在不同程度的结石残留，11例（4．47％）输尿管支架管放置不到位，4例术后3天内造瘘管脱出肾实质外，另有3例等待二期MPC—NL治疗的患者术后8～10天时肾造瘘管脱出，发生率分别为1.63％和16．67％（P〈0．001）；8例（3．252％）术中出现穿刺位置肾脏皮质撕裂，2例（0．81％）出现肾盏颈部撕裂，手术穿刺穿破肾脏动脉段内分支共计4例（1．63％），1例（O．41％）穿破肾脏中段分支动静脉，造成动静脉瘘，3例（1．22％）出现气胸，26例（10．57％）术后发生感染。结论：手术适应证的掌握、术者经验的积累和充分术前准备均有助于减少并发症，而在有些不可避免的并发症产生时，除作开放手术处理外，还可应用动脉数字显影等新技术干预或跨学科联合治疗。

The complications of mini-invasive percutaneous nephrolithotomy and its management

Objective:To investigate the categories and agents of complications and treatments in using Mini-percutaneous Nephrolithotomy (MPCNL).Methods:Totally 246 cases of patients suffering from complicated calculus of upper urinary track were treated with MPCNL and the data concerning their turnover and treatments of all complications were reviewed retrospectively.Results:There were 84 cases (34.15%) had calculus residual, 11 cases (4.47%) had mal-positioned ureter stents, 4 cases (1.63%) dislocated the tubes of renal stoma in three days, 3 cases (16.67%) lost the same tubes one week later in waiting for the second stage MPCNL (P<0.001). The renal cortex of 8 cases (3.25%) and the neck of renal calices of 2 cases (0.813%) were tore apart at the puncture position. Four cases (1.626%) had their renal artery branches damaged by the puncture and in another case (0.407%) it caused arteriovenous fistula in middle piece. Three patients (1.22%) got pneumothorax and 26 cases (10.57%) got postoperative infection.Conclusions:Good indication, expertise surgeon and sufficient preoperative preparation will decrease complications.