体外冲击波碎石术术后严重并发症的诊断与治疗

发布时间：2017-12-31 00:34

本文关键词：体外冲击波碎石术术后严重并发症的诊断与治疗　出处：《山东医药》2015年47期 　论文类型：期刊论文

【摘要】：目的探讨体外冲击波碎石术(ESWL)术后严重并发症的诊断与治疗方法。方法回顾性分析22例ESWL术后严重并发症患者的临床资料。结果 22例均伴有患侧腰部疼痛,14例伴发热。B超、KUB、IVU检查均提示患侧不同程度肾积水。肾包膜下血肿(CT检查提示肾包膜下不同程度积液)3例,经保守治疗3个月后血肿吸收。尿外渗伴腹膜后感染(CT检查提示肾包膜界限模糊,肾脏肿大,肾周脂肪间可见条索样组织,肾周脓肿可见环绕肾周的积液及分隔)7例,2例经留置双J管及抗感染治疗1周后体温、血象正常,症状消失,5例肾周脓肿患者经切开引流治疗后,脓腔消失,体温及血象正常。肾积脓(CT检查主要提示不同程度肾积水)5例,4例行输尿管镜手术或肾穿刺,解除梗阻后,症状缓解,1例重度积水肾功能丧失行肾切除术。急性肾功能不全(CT检查可见肾积水)6例,行输尿管镜手术或逆行置双J管治疗后,4例肾功能恢复正常,2例处于氮质血症期。肾萎缩(CT检查可见肾皮质萎缩变薄)1例,肾功能丧失行肾切除术。结论 ESWL术后严重并发症有肾包膜下血肿、尿外渗伴腹膜后感染、肾积脓、急性肾功能不全、肾萎缩,诊断需结合临床表现及B超、KUB、CT检查。对不同并发症需采取个性化治疗,原则为通畅引流、控制感染、及时手术、保护肾功能。
[Abstract]:Objective to explore ESWL for extracorporeal shock wave lithotripsy (ESWL). Methods the clinical data of 22 patients with severe postoperative complications after ESWL were retrospectively analyzed. 14 cases were accompanied with fever. All the patients were diagnosed as hydronephrosis in different degree by B-mode ultrasonography. Ct examination of subcapsular hematoma showed that there were 3 cases with subcapsular effusion. After 3 months of conservative treatment hematoma absorption. Urine exosmosis with retroperitoneal infection CT examination showed that the boundary of renal capsule is blurred renal swelling and stripe like tissue can be seen in perirenal fat. Perirenal abscess could be seen in 7 cases of perirenal effusion and septum. 2 cases were treated by indwelling double J tube and antiinfective therapy. After 1 week treatment, the body temperature was normal and the symptoms disappeared. 5 cases of perirenal abscess were treated by incision and drainage. The disappearance of pus cavity, normal body temperature and hematology. Ct examination of pyonephrosis showed that 5 cases of hydronephrosis with different degrees of hydronephrosis underwent ureteroscopy or renal puncture, and the symptoms were relieved after relieving the obstruction. One patient with severe hydronephrosis underwent nephrectomy, 6 patients with hydronephrosis were found to have hydronephrosis by CT scan, and 4 patients had normal renal function after ureteroscopy or retrograde double J tube placement. Two cases were in azotemia. Renal atrophy was seen in 1 case with renal cortex atrophy thinning and renal function loss was performed nephrectomy. Conclusion severe complications after ESWL are subcapsular hematoma. Urinary exosmosis with retroperitoneal infection, pyonephrosis, acute renal insufficiency, renal atrophy, diagnosis need to be combined with clinical manifestations and B-ultrasound KUBU CT examination. Different complications need to be individualized treatment. The principles are unobstructed drainage, infection control, timely operation and protection of renal function.
【作者单位】：天津市宝坻区人民医院;
【分类号】：R699
【正文快照】： 体外冲击波碎石术(ESWL)作为治疗上尿路结石的一种微创手段已在临床广泛应用[1]。但是如果未严格把握适应证和操作规范或患者伴有特殊体质,ESWL也可出现严重的并发症,甚至导致患者肾功能丧失并危及生命。因此,临床上需明确诊断,积极正确处理ESWL术后并发症。2010年3月~2014年1

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