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目的:探讨经皮肾微造瘘输尿管镜取石术(MPCNL)的并发症及防治方法。方法:回顾性分析本中心2008年10月～2010年10月MPCNL治疗的180例患者临床资料,总结相关的手术并发症。结果:本组患者Ⅰ期MPCNL术后出现残留结石70例(38.8%),发生并发症47例(26.1%),其中肾皮质裂伤4例(2.2%),肾盏颈部撕裂伤2例(1.1%),肾小动脉(Ⅱ、Ⅲ级分支)裂伤5例(2.8%),肾动脉静瘘1例(0.5%),输尿管支架管放置不佳10例(5.5%),肾造瘘管脱出1例(0.5%),液气胸2例(1.1%),术后感染22例(12.2%),均治愈出院。结论:手术适应证的掌握、术者经验的积累和充分的术前准备,均有助于减少MPCNL治疗上尿路结石相关并发症的发生。
Objective: To investigate the complications and prevention and treatment of percutaneous nephrostomy ureteroscopic lithotripsy (MPCNL). Methods: The clinical data of 180 patients treated by MPCNL from October 2008 to October 2010 in our center were retrospectively analyzed, and the related operative complications were summarized. Results: There were 70 (38.8%) residual stones in stage I MPCNL and 47 (26.1%) complications occurred in this group, including 4 cases of renal cortical laceration (2.2%) and 2 cases of cervical laceration (1.1%), laceration of renal arteries (Ⅱ, Ⅲ grade) in 5 cases (2.8%), renal artery fistula in 1 case (0.5%), ureteral stent placement in 10 cases One case (0.5%) had fistula prolapse, two cases of liquid pneumothorax (1.1%), and 22 cases (12.2%) of postoperative infection were cured and discharged. Conclusion: The mastery of operative indications, the accumulation of experience and the adequate preoperative preparation all help to reduce the incidence of upper urinary tract stones associated with MPCNL.