【摘要】 目的探讨微创经皮肾取石(MPCNL)术治疗上尿路结石患者手术并发症的防治。方法回顾2004年4月～2008年4月微创经皮肾气压弹道碎石治疗上尿路结石患者358例资料,分析其并发症的防治措施和转归。结果358例行425例次手术,发生并发症43例次(10%)。其中术中大出血3例(0.71%),1例改开放手术,2例夹闭肾盂造瘘管后观察无明显出血,1周后行Ⅱ期取石;术后迟发大出血1例(0.23%),经输血及超选择性肾动脉栓塞治愈;肾盂穿孔17例(3.95%)和术后高热、感染15例(3.49%),均经抗感染和引流后治愈;术后造瘘管滑脱7例(1.62%),2例行Ⅱ期取石者重新穿刺置管,5例未作特殊处理。无胸膜损伤及腹腔内脏器损伤。结论术中、术后继发大出血及术后感染是MPCNL最常见的并发症,应做到早期发现和及时处理。更多还原

【Abstract】 Objective To investigate the prevention and management of complications of minimally invasive percutaneous nephrolithotomy (MPCNL). MethodsFrom April 2004 to April 2008, totally 358 cases of patients suffering from complicated calculi of upper urinary track were treated with MPCNL and the data concerning their turnover and treatments of all complications were reviewed retrospectively. ResultsAmong 425 operations for the 358 patients, complications were found in 43 (10.0%). Severe hemorrhage were found in 3 patients (0.71%) during operation, among which 1 case were treated by open operation, 2 cases were cured by clipping renal pelvis fistula and were treated by second stage MPCNL after a week. One patient (0.23%) had severe postoperative hemorrhage and successfully treated by blood transfusion and super-selective arterial embolism. Seventeen (3.95%) cases had perforated pelvis and 15 cases (3.49%) got postoperative infection and high fever which were cured after the anti-inflammation and drainage. Seven cases (1.62%) had dislocated fistula tubes, among which 2 cases were treated by second stage MPCNL to set the tube again and 5 cases did not have special handling. There was injury of neither pleura nor abdominal organ. ConclusionSevere renal hemorrhage during and after operation, and postoperative infection are the common and severe complications of MPCNL and they must be discovered as early as possible and measured immediately.更多还原