Clinical analysis and treatment of complications of ultrasound-guided minimally invasive percutaneous nephrolithotomy
10.3760/cma.j.issn.1000-6702.2012.01.008
- VernacularTitle:B超引导下微创经皮肾镜取石术并发症分析
- Author:
Qi CHEN
;
Jiwei HUANG
;
Lei XIA
;
Jiahua PAN
;
Wei XUE
;
Yiran HUANG
- Publication Type:Journal Article
- Keywords:
Mini-percutaneous nephrolithotomy;
Complication;
Prevention
- From:
Chinese Journal of Urology
2012;33(1):24-28
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the occurrence and management of complications following ultrasound-guided minimally invasive percutaneous nephrolithotomy (MPCNL). MethodsFrom November 2003 to January 2011,2300 cases of ultrasound - guided MPCNL were performed for upper urinary tract stones in our department.Of these cases,renal calculi were found in 1305 cases,upper ureteral calculi in 322,renal and coexisting ureteral stones in 673. Results Among the 2300 cases of MPCNL,a total of 756 (32.9％) patients encountered complications.Of these cases,peel-away sheath placement failure occurred in 184 cases( 8.0％ ),in which six cases needed secondary surgery.Collecting system perforation occurred in 308 cases ( 13.4％ ),fever in 303 cases ( 13.2％ ),including septicemia in 20 cases (0.87％).The 20 septicemia patients received intensive antibiotic treatment and were successfully cured.Thrity-six patients required transfussions due to severe hemorrhaging ( 1.57％ ).Renal vein injury occurred in three cases (0.13％),for which these patients received intensive care therapy to provide haemostasis with a second procedure months later.There was extensive hemorrhage in 16 cases (0.70％) post-MPCNL,super-selective renal artery embolisation was performed in 12 cases and nephrectomy in 1 case.Pleural injury occurred in one case (0.04％) and pleural effusion in two cases (0.09％),all of which were cured with conservative therapy.There were no cases of abdominal organ injury.ConclusionsThe rate of ultrasound guided complications in MPCNL was lower than that of X-ray guided MPCNL in adjacent organ injury,but higher in complications related to the access ( such as:peel-away sheath placement failure,collecting system perforation),parenchymal bleeding and fever.Most complications (i.e.,bleeding,fever) could be managed conservatively or with minimally invasive procedures ( i.e.superselective renal embolisation,antibiotics treatment) when the complications were recognized early.Renal severe hemorrhage in operation,delayed hemorrhage and infection after MPCNL were several of the severe complications that required active prevention and cure measurement.
