Emiliani Esteban, Talso Michele, Beltrán-Suárez Edgar, Doizi Steeve, Traxer Olivier
Department of Urology, Hôpital Tenon, Université Pierre et Marie Curie Paris VI, Paris, France.; Groupe de Recherche Clinique sur la Lithiase Urinaire, GRC n° 20, Sorbonne Universités, Paris VI, France.
Department of Urology, Hôpital Tenon, Université Pierre et Marie Curie Paris VI , Paris, France .
J Endourol Case Rep. 2016 Nov 1;2(1):224-226. doi: 10.1089/cren.2016.0108. eCollection 2016.
Flexible ureteroscopy (fURS) is one of the main treatment options for urolithiasis less than 2 cm. Although fURS has no relative contraindication, some anatomical factors may need to be considered, as not all patients are suitable for the regular lithotomy position (LP). We report the case of a patient with a right iliac vascular graft that after an fURS without intraoperative incidences developed a reperfusion syndrome of the right lower limb. A 46-year-old male patient was referred for treatment and follow-up in the cystinuric clinic after being found to have a 3 cm pelvic stone with a Double-J catheter in place after two failed sessions of shockwave lithotripsy. The patient was placed in the LP and a standard ureteroscopy was done with no intraoperative complications. During the first hour in the recovery room, the patient developed severe pain in the right calf muscle stiffness, edema, and increased volume. A postreperfusion and compartment syndrome diagnosis was made with emergency fasciotomy. To perform fURS, each case must be assessed individually. If a patient with an iliac vascular graft has to undergo fURS, the patient positioning must be modified by keeping the ipsilateral (or both) legs straight to avoid graft complications.
软性输尿管镜检查（fURS）是治疗小于2厘米尿路结石的主要方法之一。尽管fURS没有相对禁忌症，但一些解剖学因素可能需要考虑，因为并非所有患者都适合常规的截石位（LP）。我们报告了一例右髂血管移植患者的病例，该患者在fURS术后无术中并发症，但出现了右下肢再灌注综合征。一名46岁男性患者在两次冲击波碎石术失败后，被发现有一枚3厘米的盆腔结石并留置双J导管，随后被转诊至胱氨酸尿症诊所进行治疗和随访。患者采用截石位，进行了标准输尿管镜检查，术中无并发症。在恢复室的第一个小时内，患者出现右小腿严重疼痛、肌肉僵硬、水肿和体积增大。诊断为再灌注和骨筋膜室综合征，并进行了急诊筋膜切开术。为了进行fURS，每个病例都必须单独评估。如果有髂血管移植的患者必须接受fURS，患者体位必须调整，保持同侧（或双侧）腿伸直，以避免移植相关并发症。
