CAJ | 학술논문

目的探讨体外冲击波碎石术(ESWL)后严重并发症的处理方法. 方法回顾性分析2008年1月至2013年6月收治的21例ESWL术后严重并发症患者的临床资料,男10例,女11例.年龄34～71岁,平均47岁.21例曾行ESWL治疗1～21次,平均3次.肾脏ESWL 14例,输尿管ESWL 7例,其中双侧同时行ESWL 1例.14例伴有发热,体温最高42.1℃.尿常规:WBC(+～+++),血常规:WBC 10.5～ 23.4× 106/L.6例SCr 230～1 110 μmol/L.21例均行B超、KUB和泌尿系CT平扫检查,5例行增强扫描.临床诊断为肾包膜下血肿3例,尿外渗伴腹膜后感染6例,肾积脓5例,急性肾功能不全6例,肾萎缩1例. 结果 3例肾包膜下出血经保守治疗3个月后血肿吸收.6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周后体温及血象正常,症状消失,4例肾周脓肿患者经切开引流治疗后,脓腔消失,体温及血象正常.5例肾积脓中4例行输尿管镜手术或肾穿刺,解除梗阻后,症状缓解,1例重度积水肾功能丧失行肾切除术.6例肾功能不全行输尿管镜手术或逆行置双J管治疗后,4例肾功能恢复正常,2例处于氮质血症期.1例肾萎缩,肾功能丧失行肾切除术. 结论 ESWL引起的严重并发症可导致严重后果,明确诊断后应积极采取有效的措施进行处理.
목적 탐토체외충격파쇄석술(ESWL)후엄중병발증적처리방법. 방법 회고성분석2008년1월지2013년6월수치적21례ESWL술후엄중병발증환자적림상자료,남10례,녀11례.년령34～71세,평균47세.21례증행ESWL치료1～21차,평균3차.신장ESWL 14례,수뇨관ESWL 7례,기중쌍측동시행ESWL 1례.14례반유발열,체온최고42.1℃.뇨상규:WBC(+～+++),혈상규:WBC 10.5～ 23.4× 106/L.6례SCr 230～1 110 μmol/L.21례균행B초、KUB화비뇨계CT평소검사,5례행증강소묘.림상진단위신포막하혈종3례,뇨외삼반복막후감염6례,신적농5례,급성신공능불전6례,신위축1례. 결과 3례신포막하출혈경보수치료3개월후혈종흡수.6례뇨외삼반복막후감염중,2례경류치쌍J관급항감염치료1주후체온급혈상정상,증상소실,4례신주농종환자경절개인류치료후,농강소실,체온급혈상정상.5례신적농중4례행수뇨관경수술혹신천자,해제경조후,증상완해,1례중도적수신공능상실행신절제술.6례신공능불전행수뇨관경수술혹역행치쌍J관치료후,4례신공능회복정상,2례처우담질혈증기.1례신위축,신공능상실행신절제술. 결론 ESWL인기적엄중병발증가도치엄중후과,명학진단후응적겁채취유효적조시진행처리.
Objective To study the treatment and prevention of severe complications after extracorporeal shock-wave lithotripsy (ESWL).Methods We retrospectively analyzed the clinical data of 21 cases with severe complications after ESWL,including 10 males and 11 females,with average age of 47 (34-71) years.All 21 cases underwent ESWL,with average of 3(1-21) times.7 cases had calculi in ureter and 14 had calculi in kidney.1 case was treated bilaterally.14 cases had fever and the highest temperature was 42.1 ℃.Urinalysis of 21 cases was found abnormal and white blood cell showed positive(+-+++).Complete blood count also appeared abnormal and white blood cell exceeded normal range from 10.5 to 23.4× 106/L.SCr of 6 cases were abnormal fromn 230 to 1 110 μmol/L.All the cases were checked with ultrasound,KUB and CT scan,included 5 cases underwent enhanced CT scan.The severe complications post-ESWL were listed as following:3 renal subcapsular hematoma,6 urinary extravasation with retroperitoneal infection,5 pyelonephritis,6 acute renal failure and 1 renal atrophy after operation.All patients were treated properly according to the respective condition.Results 3 renal subcapsular hematoma had absorbed by non-surgical treatment after 3 months.In 6 cases with urinary extravasation with retroperitoneal infection,2 were recovered by placing double J stents and antibiotics after 1 week.4 cases with renal abscess were healed with incision and drainage operation.In 5 cases with pyelonephritis,symptoms of 4 cases relieved by ureteroscopic operation or nephrostomy.1 case underwent nephrectomy due to severe hydronephrosis and empyemata.6 cases with actute renal failure were relieved by ureteroscopic operation or placing double J stents.2 cases with acute renal failure were caught in SCr levels of compensation stage.The others 4 were recovered completely.1 case underwent nephrectomy due to renal atrophy and loss of function.Conclusions The severe complications post-ESWL are common to seen in clinical practice,but most of them can be forecasted and prevented.Diagnosing exactly and treating properly are the most important strategy.