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目的探讨B超引导下经皮肾镜碎石取石术(PCNL)治疗上尿路结石患者手术并发症的防治。方法回顾性分析2007年4月至2010年12月我科采用B超引导下PCNL治疗上尿路结石85例患者的临床资料,分析其并发症的防治措施和转归。结果 85例患者中,83例成功施行经皮肾穿刺并建立F24经皮肾通道进行碎石术,2例因经皮肾通道扩张和碎石时大出血而中止手术。术中、术后发生并发症8例(9.41%),其中经皮肾穿刺损伤胸膜、气胸1例,经皮肾通道扩张和碎石时大出血2例,术后感染(术后体温>38.5℃持续2d以上)4例,1例患者于术后第4天突然从肾盂造漏管和造漏口流出大量不凝血,经输血400ml及超选择性肾动脉栓塞后治愈。结论术中、术后继发大出血及术后感染是PCNL最常见的并发症,应做到早期发现和及时处理。
Objective To investigate the prevention and treatment of surgical complications in patients with upper urinary calculi treated with percutaneous nephrolithotomy guided by B-ultrasonography. Methods The clinical data of 85 patients with upper urinary tract calculi underwent B-guided PCNL from April 2007 to December 2010 were retrospectively analyzed. The prevention and treatment of complications and prognosis were analyzed. Results Of the 85 patients, 83 were successfully treated with percutaneous nephrolithotomy and F24 percutaneous nephrostomy was performed. Two patients discontinued surgery due to percutaneous renal enlargement and massive hemorrhage at gravel. There were 8 cases (9.41%) of complications occurred during and after operation. Among them, pleural perforation, 1 case of pneumothorax, 2 cases of hemorrhage after percutaneous renal channel dilatation and lithotripsy, postoperative infection (body temperature> 38.5 ℃ Continued for more than 2d) 4 cases, 1 patient in the fourth day after surgery suddenly from the leakage tube and leakage of the pelvis out of a large flow of non-coagulation, transfusion 400ml and super selective renal artery embolization cured. Conclusion Intraoperative and postoperative secondary hemorrhage and postoperative infection are the most common complication of PCNL. Early detection and timely treatment should be done.