本文關(guān)鍵詞：體外沖擊波碎石術(shù)術(shù)后嚴(yán)重并發(fā)癥的診斷與治療　出處：《山東醫(yī)藥》2015年47期 　論文類型：期刊論文

  更多相關(guān)文章： 體外沖擊波碎石術(shù) 手術(shù)并發(fā)癥 泌尿系結(jié)石

【摘要】：目的探討體外沖擊波碎石術(shù)(ESWL)術(shù)后嚴(yán)重并發(fā)癥的診斷與治療方法。方法回顧性分析22例ESWL術(shù)后嚴(yán)重并發(fā)癥患者的臨床資料。結(jié)果 22例均伴有患側(cè)腰部疼痛,14例伴發(fā)熱。B超、KUB、IVU檢查均提示患側(cè)不同程度腎積水。腎包膜下血腫(CT檢查提示腎包膜下不同程度積液)3例,經(jīng)保守治療3個月后血腫吸收。尿外滲伴腹膜后感染(CT檢查提示腎包膜界限模糊,腎臟腫大,腎周脂肪間可見條索樣組織,腎周膿腫可見環(huán)繞腎周的積液及分隔)7例,2例經(jīng)留置雙J管及抗感染治療1周后體溫、血象正常,癥狀消失,5例腎周膿腫患者經(jīng)切開引流治療后,膿腔消失,體溫及血象正常。腎積膿(CT檢查主要提示不同程度腎積水)5例,4例行輸尿管鏡手術(shù)或腎穿刺,解除梗阻后,癥狀緩解,1例重度積水腎功能喪失行腎切除術(shù)。急性腎功能不全(CT檢查可見腎積水)6例,行輸尿管鏡手術(shù)或逆行置雙J管治療后,4例腎功能恢復(fù)正常,2例處于氮質(zhì)血癥期。腎萎縮(CT檢查可見腎皮質(zhì)萎縮變薄)1例,腎功能喪失行腎切除術(shù)。結(jié)論 ESWL術(shù)后嚴(yán)重并發(fā)癥有腎包膜下血腫、尿外滲伴腹膜后感染、腎積膿、急性腎功能不全、腎萎縮,診斷需結(jié)合臨床表現(xiàn)及B超、KUB、CT檢查。對不同并發(fā)癥需采取個性化治療,原則為通暢引流、控制感染、及時手術(shù)、保護(hù)腎功能。
[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.
【作者單位】： 天津市寶坻區(qū)人民醫(yī)院;
【分類號】：R699
【正文快照】： 體外沖擊波碎石術(shù)(ESWL)作為治療上尿路結(jié)石的一種微創(chuàng)手段已在臨床廣泛應(yīng)用[1]。但是如果未嚴(yán)格把握適應(yīng)證和操作規(guī)范或患者伴有特殊體質(zhì),ESWL也可出現(xiàn)嚴(yán)重的并發(fā)癥,甚至導(dǎo)致患者腎功能喪失并危及生命。因此,臨床上需明確診斷,積極正確處理ESWL術(shù)后并發(fā)癥。2010年3月~2014年1

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