微通道经皮肾镜取石术中胸腹腔积液的回顾性分析

发布时间：2018-11-06 21:11

【摘要】：目的：探讨微通道经皮肾镜取石术治疗肾结石术中并发胸腹腔积液的诊断和处理方法。方法：2008年4月至2013年4月320例肾结石患者接受微通道经皮肾镜取石，对其中10例术中并发胸腹腔积液的患者资料作回顾性分析。结果：本组男性8例，女性2例,年龄31～59岁,平均年龄39.5岁；左侧肾结石7例，右侧3例，结石大小1.0cm×2.0cm×2.5cm～1.8cm×2.5cm×4.0cm，为铸型结石，并发轻度肾积水3例。在B超定位下经第11肋间或12肋骨下穿刺，术中发现6例轻度胸腹腔积液，2例出现严重的胸腹腔积液，，另术后发现2例轻度胸腹腔积液，分别经胸腔引流、腹腔引流和保守治疗后治愈。本组微通道经皮肾镜取石术治疗肾结石术中并发胸腹腔积液发生率为3.1%（10/320）,9例随访3月无异常发现，1例肾功能无改善。结论：微通道经皮肾镜取石术治疗肾结石术中可并发胸腹腔积液,术中B超检查可明确诊断；严重的胸腹腔积液术中必须立刻引流,轻度的胸腹腔积液术后可自行吸收。术中仔细观察、减低灌注液压力、减少胸腹膜损伤等是防止微通道经皮肾镜取石术中胸腹腔积液的关键。
[Abstract]:Objective: to investigate the diagnosis and management of microchannel percutaneous nephrolithotomy in the treatment of renal calculi complicated with hydrothorax and peritoneal effusion. Methods: from April 2008 to April 2013, 320 patients with renal calculi underwent percutaneous nephrolithotomy. The data of 10 patients with intraoperative hydrothorax and peritoneal effusion were analyzed retrospectively. Results: there were 8 males and 2 females with a mean age of 39.5 years (31 ~ 59 years). There were 7 cases of left kidney stone and 3 cases of right side kidney stone. The size of stone was 1.0cm 脳 2.0cm 脳 2.5cm~1.8cm 脳 2.5cm 脳 4.0 cm, which was cast stone, and mild hydronephrosis occurred in 3 cases. Six cases of mild pleural and peritoneal effusion, 2 cases of severe hydrothorax and celiac effusion, 2 cases of mild pleural and peritoneal effusion and 2 cases of mild pleural and celiac effusion were found under B-ultrasound localization through the 11th intercostal or 12 subcostal puncture. Abdominal drainage and conservative treatment were cured. The incidence of hydrothorax and celiac effusion was 3.1% (10 / 320) in patients with renal calculi treated by percutaneous nephrolithotomy. 9 cases were followed up for 3 months and 1 case had no improvement in renal function. Conclusion: microchannel percutaneous nephrolithotomy in the treatment of renal calculi can be accompanied by hydrothorax and peritoneal effusion, and the intraoperative B-ultrasound examination can be clearly diagnosed, the severe hydrothorax and peritoneal effusion must be drained immediately and the mild hydrothorax and celiac effusion can be absorbed by itself after operation. Careful observation during operation, reduction of perfusion fluid pressure and reduction of pleural injury are the key to prevent hydrothorax and peritoneal effusion during microchannel percutaneous nephrolithotomy.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.4

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