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经皮肾镜碎石取石术后下腔静脉损伤及继发血栓形成的处理:1 例报告。

Management of inferior vena cava injury and secondary thrombosis after percutaneous nephrolithotomy: a case report.

机构信息

Department of Urology, The First Affiliated Hospital of Hunan University of Medicine, Huaihua City, Hunan Province, China *Co-first author.

出版信息

J Int Med Res. 2021 Nov;49(11):3000605211058868. doi: 10.1177/03000605211058868.

Abstract

Percutaneous nephrolithotomy (PCNL) remains an important method for treating upper urinary calculi. However, bleeding and peripheral vascular injury are serious complications of PCNL. Injury of the inferior vena cava accompanied by secondary thrombosis has rarely been reported clinically. We treated a patient who experienced bleeding during PCNL to establish a channel. A catheter was used to make a renal fistula, and the inferior vena cava was implanted. The wound was fixed and compressed by balloon injection, and secondary thrombosis and repeated infection occurred after the operation. A filter was then placed, the water balloon was released, and the fistula was removed. The anti-bacterial and anticoagulant filter was removed. This major complication was successfully managed. In our patient, during PCNL, the renal fistula entered the inferior vena cava by mistake. If this issue cannot be treated in time, it can easily lead to the formation of secondary thrombosis. A fistula can be extracted through an inferior vena cava filter, and anticoagulant treatment and other conservative treatment regimens can be used to treat patients in this situation. These treatments avoid the possibility of further damage from open surgery.

摘要

经皮肾镜碎石术(PCNL)仍然是治疗上尿路结石的重要方法。然而,出血和外周血管损伤是 PCNL 的严重并发症。下腔静脉损伤伴继发血栓形成在临床上很少见。我们治疗了一例在 PCNL 过程中发生出血以建立通道的患者。使用导管制作肾造口,植入下腔静脉。通过球囊注射固定和压迫伤口,术后发生继发性血栓形成和反复感染。然后放置了一个过滤器,释放水球囊,并取出了瘘管。取出了抗菌和抗凝的过滤器。成功处理了这一重大并发症。在我们的患者中,在 PCNL 过程中,肾造口误入下腔静脉。如果不能及时处理这个问题,很容易导致继发性血栓形成。可以通过下腔静脉过滤器提取瘘管,并可以使用抗凝治疗和其他保守治疗方案来治疗这种情况的患者。这些治疗方法避免了开放性手术进一步损伤的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bdc4/8647260/2dc7db626f19/10.1177_03000605211058868-fig1.jpg

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