Guella Adnane, Al Oraifi Ibrahim
Department of Nephrology, Fahd Military Medical Complex, Dhahran, Saudi Arabia.
Saudi J Kidney Dis Transpl. 2013 Mar;24(2):330-2. doi: 10.4103/1319-2442.109597.
Operative positions commonly used in urogenital surgeries when perineal exposure is required include the lithotomy and the exaggerated lithotomy positions (LPs), which expose patients to the risk of rhabdomyolysis. We report a patient with bladder outflow obstruction, benign prostatic hypertrophy and a very large bladder stone, which was removed with cystoscopy and cystolitholapaxy in the LP. The procedure was complicated by posterior bladder perforation and abdominal distention leading to prolonged surgery duration (5.5 h). The patient developed rhabdomyolysis and acute renal failure (ARF) without compartmental syndrome. On the other hand, there was a potential role of glycine solution, used for bladder irrigation, in the appearance of ARF. Overall, our case shows that rhabdomyolysis and ARF can develop in operative positions, and duration of surgery is the most important risk factor for such complications.
在需要暴露会阴的泌尿生殖系统手术中常用的手术体位包括截石位和过度截石位，这会使患者面临横纹肌溶解的风险。我们报告了一名患有膀胱流出道梗阻、良性前列腺增生和非常大的膀胱结石的患者，该结石在过度截石位下行膀胱镜检查和膀胱碎石取石术时被取出。手术出现了膀胱后壁穿孔和腹胀的并发症，导致手术时间延长（5.5小时）。患者发生了横纹肌溶解和急性肾衰竭（ARF），但无骨筋膜室综合征。另一方面，用于膀胱冲洗的甘氨酸溶液在急性肾衰竭的发生中可能起到了一定作用。总体而言，我们的病例表明，横纹肌溶解和急性肾衰竭可在手术体位中发生，而手术时间是此类并发症最重要的危险因素。
