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目的:探讨围麻醉期经皮肾穿刺微造瘘输尿管镜取石术并发症原因及处理措施。方法:对454例已行经皮肾穿刺微造瘘输尿管镜取石术治疗上尿路结石患者的临床资料进行回顾分析。根据年龄不同分为4组:Ⅰ组(≤14岁)17例;Ⅱ组(15~39岁)163例;Ⅲ组(40~59岁)197例;Ⅳ组(≥60岁)87例。结果:454例次手术、手术时间1.14±0.58h。IV组的MAP和HR变化较明显(P<0.05~0.01)。术中发生胸腔积水致呼吸困难2例(0.44%);术中出血严重9例(1.1%);肠穿孔2例(0.44%);术后发现腹腔积液3例(0.66%);腹膜后积液21例(4.62%)。结论:围麻醉期经皮肾穿刺微造瘘输尿管镜取石术可能发生大出血,肠穿孔,腹腔、胸腔、腹膜后积液,围术期的监测及时处理极为重要。
Objective: To investigate the complications and treatment of ureteroscopic lithotripsy during percutaneous nephrostomy percutaneous nephrostomy. Methods: The clinical data of 454 patients who underwent percutaneous nephrostomy and ureteroscopic lithotripsy in the treatment of upper urinary tract stones were retrospectively analyzed. According to different age groups were divided into four groups: Ⅰ group (≤ 14 years old) in 17 cases; Ⅱ group (15 to 39 years old) 163 cases; Ⅲ group (40 to 59 years old) 197 cases; Ⅳ group (≥ 60 years) 87 cases. Results: 454 cases underwent surgery, the operation time was 1.14 ± 0.58h. The changes of MAP and HR in IV group were more obvious (P <0.05 ~ 0.01). There were 2 cases (0.44%) with dyspnea caused by pleural effusion in operation, 9 cases (1.1%) with severe intraoperative bleeding, 2 cases with intestinal perforation (0.44%), 3 cases (0.66%) with peritoneal effusion after operation, After the effusion in 21 cases (4.62%). Conclusion: Percutaneous nephrostomy and ureteroscopic lithotripsy of percutaneous nephrostomy percutaneous nephrostomy may cause massive hemorrhage, intestinal perforation, peritoneal cavity, thoracic cavity, retroperitoneal effusion and perioperative monitoring and timely treatment.