Kastelan Z, Derezic D, Pasini J, Stern-Padovan R, Skegro M, Mrazovac D, Sosic H
Universitätsklinik für Urologie, KBC Zagreb-Rebro, Kroatien.
Aktuelle Urol. 2005 Nov;36(6):519-21. doi: 10.1055/s-2005-870971.
ESWL is a safe and efficient method in the therapy of urolithiasis which, however, is not free of complications.
ESWL was performed in a 54-year-old patient with a stone of 18 mm in size located in one of the upper calyces of the left kidney. Several hours after the ambulatory ESWL treatment the patient was admitted to the emergency room with strong pain in the left lumbar region and the upper abdomen. During examination low blood pressure, tachycardia and low Hb levels were found. Ultrasound and CAT scans revealed a subcapsular rupture of the spleen. Surgery was indicated, and a laparotomy with splenectomy was performed. Ten days after surgery the patient developed acute pancreatitis which was treated conservatively with success.
Although ESWL is a safe method in the treatment of urinary stones with a relatively small number of complications, rare complications like ruptures of the spleen have to be considered. Special attention should be given to patients with kidney stones in the left upper calyces, pathological growth of the spleen, and accompanying diseases such as chronic heart failure or hypertension. In such patients ESWL should not be performed on an outpatient basis.
体外冲击波碎石术（ESWL）是治疗尿石症的一种安全有效的方法，然而，它并非没有并发症。
对一名54岁的患者进行了ESWL治疗，其左肾一个上肾盏中有一颗18毫米大小的结石。门诊ESWL治疗数小时后，患者因左腰区和上腹部剧痛被送入急诊室。检查发现血压低、心动过速和血红蛋白水平低。超声和计算机断层扫描显示脾脏包膜下破裂。需要进行手术，遂实施了剖腹脾切除术。术后十天，患者发生急性胰腺炎，经保守治疗成功。
尽管ESWL是治疗尿路结石的一种安全方法，并发症相对较少，但必须考虑到如脾脏破裂等罕见并发症。对于左上肾盏有肾结石、脾脏病理性增大以及伴有慢性心力衰竭或高血压等伴随疾病的患者应给予特别关注。在此类患者中，不应在门诊进行ESWL治疗。
