体外冲击波碎石术后少见并发症临床分析

发布时间：2018-04-13 15:04

本文选题：上尿路结石 + 体外冲击波碎石术　；参考：《山东医药》2017年02期

【摘要】：目的探讨体外冲击波碎石(ESWL)术后少见并发症的临床特点及诊治方法。方法回顾性分析13例ESWL术后发生少见并发症(如感染性休克、肾积水、肾周脓肿等)的上尿路结石患者的临床资料。结果患者男8例、女5例,平均年龄48.1岁;伴有高血压、冠心病5例,2型糖尿病4例。12例曾行ESWL治疗平均3次,1例外院曾行ESWL治疗10余次;行肾结石ESWL 4例,输尿管结石ESWL 9例,其中双侧同时行ESWL 1例。患者就诊时均伴有患侧腰部疼痛,伴发热4例,并发感染性休克1例;患者均行B超及腹部平片X线检查及泌尿系CT平扫+增强扫描,均提示患侧不同程度肾积水。4例肾包膜下出血经保守治疗后血肿未继续扩大。3例尿外渗伴腹膜后感染中,2例经留置双J管及抗感染治疗1周后体温及血常规检查结果正常,症状消失;1例腹膜后感染形成肾周脓肿,出现感染性休克表现,经切开引流、抗感染等处理后痊愈。2例肾功能衰竭急行输尿管镜手术或逆行置双J管治疗,肾功能恢复正常。1例输尿管上段破裂行输尿管镜碎石术,术后放置输尿管支架管、抗感染治疗,漏口自行愈合。1例上消化道出血经抗酸解痉及对症支持处理,1周后出血停止。1例阴道出血者第2天出血量即明显减少,1周内出血消失。1例肾萎缩行肾切除术,术后肾功能代偿正常。结论 ESWL术后少见并发症多见于有合并症及治疗次数多的上尿路结石患者,影像学检查有助于及早发现,及时合理处理可避免导致严重后果。
[Abstract]:Objective to investigate the clinical features, diagnosis and treatment of rare complications after extracorporeal shock wave lithotripsy (ESWL).Methods the clinical data of 13 patients with upper urinary tract calculi with rare complications such as septic shock, hydronephrosis and perirenal abscess after ESWL were analyzed retrospectively.Results there were 8 males and 5 females with an average age of 48.1 years, 4 patients with hypertension, 5 patients with type 2 diabetes mellitus and 12 patients with coronary heart disease who had been treated with ESWL for an average of 3 times. One exception had been treated with ESWL for more than 10 times, and 4 patients with renal calculi were treated with ESWL.ESWL was performed in 9 patients with ureteral calculi, in which ESWL was performed on both sides in 1 case.All the patients were accompanied with lumbar pain, fever in 4 cases and septic shock in 1 case.All the results indicated that the hematoma of 4 patients with renal hydronephrosis with different degrees of hydronephrosis did not expand further after conservative treatment. 2 out of 3 patients with urinary exosmosis and retroperitoneal infection had normal results of body temperature and blood routine examination after one week of indwelling double J tube and anti-infection treatment.One case with retroperitoneal infection formed perirenal abscess and presented with septic shock. 2 cases of renal failure were cured by incision and drainage, anti-infection and so on. 2 cases of renal failure were treated with ureteroscope or retrograde double J tube.Renal function returned to normal. 1 cases of upper ureteral rupture were treated with ureteroscopic lithotripsy.After 1 week of anti-acid antispasmolysis and symptomatic support treatment, the bleeding volume of 1 cases of vaginal bleeding stopped on the second day was significantly reduced. 1 case of renal atrophy disappeared after 1 week of renal atrophy and underwent nephrectomy.Renal function compensation was normal after operation.Conclusion the rare complications after ESWL are often seen in patients with upper urinary calculi with complications and many times of treatment. Imaging examination is helpful for early detection and timely and reasonable treatment can avoid serious consequences.
【作者单位】：首都医科大学石景山教学医院北京市石景山医院;
【分类号】：R699

【相似文献】