微创经皮肾镜取石术的并发症及其防治

目的 探讨微创经皮肾镜取石术(MPCNL)并发症的发生情况及防治措施.方法 2001年1月至2006年2月行MPCNL 4326例,其中男性2451例,女性1875例;年龄4～82岁,平均42岁.单发肾盂肾盏结石1221例,鹿角状肾结石1735例,输尿管上段结石386例,体外冲击波术后严重石街90例,开放手术后残留结石894例.结果 4326例手术出现并发症445例(10.3%),其中严重肾出血20例,胸膜损伤13例,结肠损伤1例,术后发热343例(T＞38℃),感染性休克13例,肾周尿性囊肿16例,肾周脓肿9例,肾贯通伤26例,导丝误入下腔静脉1例,死亡3例.结论 MPCNL虽然是微创手术,但仍可能产生严重的并发症,加强并发症的防治有利于此项技术的开展.

Complications of minimally-invasive percutaneous nephrolithotomy

OBJECTIVE: To evaluate the occurrence and management of complications following minimally invasive percutaneous nephrolithotomy (MPCNL). METHODS: The data of 4326 cases of MPCNL from January 2001 to February 2006 were reviewed, including 2451 male cases and 1875 female cases. Their age ranged from 4 to 82 years with a mean of 42 years. Of 4326 cases, 1221 cases had simple nephrolithiasis, 1735 staghorn nephrolithiasis, 386 upper ureterolithiasis, 90 serious steinstrasse after extracorporeal shock wave lithotripsy, and 894 residual calculi after open surgery. RESULTS: Among the 4326 cases of MPCNL, complications occurred in 445 cases (10.3%). Of the 445 cases, 20 had massive hemorrhage, 13 pleural injuries, 1 colonic perforation, 343 fever attacks (T > 38 degrees C), 13 septic shocks, 16 perinephric urinoms, 9 perinephric abscess, 26 renal perforating injuries, 1 guide wire misleaded into inferior vena cava, 3 died. CONCLUSIONS: MPCNL is a minimally invasive operation. However, serious complications would occur if the procedure were ignored. The improvement in the prevention and management of complications can promote the application of this procedure.