Analysis of the etiology and prognosis of severe complications after percutaneous nephrolithotomy / 中华泌尿外科杂志

ABSTRACT

Objective To analyze the etiology and prognosis of severe complications of percutaneous nephrolithotomy (PCNL).Methods The clinical data of patients with severe complications after PCNL from December 2004 to December 2015 were retrospectively analyzed.Age of the patients ranged from 25 to 69 years old,with an average of 41 years.There were 64 cases with 29 male and 35 female.Fifty-five cases were diagnosed as renal calculi,including 21 cases of left renal calculi,19 cases of right renal calculi;15 cases of bilateral renal calculi;2 cases of the patients were bilateral upper ureteral calculi;7 patients were renal calculi upper ureteral calculi on the other side.In all cases,the maximum diameter of calculus was 1.8-4.3 cm (mean 2.6 cm) and hydronephrosis depth was 0-5.9 cm (mean 2.3 cm);15 cases were previously treated with nephrolithotomy.The modified Clavien grading system was used to evaluate surgical complications,and ≥grade Ⅲ complications were considered as serious complications.Results Among the 64 cases,28 cases were classified as Clavien Ⅲ class.There were 2 cases of bleeding in operation due to renal parenchyma laceration or multiple access,patients were treated with later open surgery.Postoperative bleeding were revealed in 22 cases,16 of which were hemorrhage from the nephrostomy tubes,4 of which complained of discontinuity gross hematuria and 2 postoperative bleeding were encountered during the nephrostomy tube remove.All the cases received renal arteriography and were diagnosed with pseudoaneurysm,bleeding were stopped after embolization.3 cases of pleural injury were treated with closed thoracic drainage,1 colon injury was treated with open colostomy.There were 32 cases of urinary sepsis considered as Clavien Ⅳ complications,and these patients were transferred to the Intensive Care Unit.Clavien Ⅴ class 4 cases1 died of hemorrhagic shock due to pleural injury,2 cases died of urinary sepsis and multiple organ failure and another case died of pulmonary embolism.Conclusions PCNL has high risk of serious complications,which should be always strictly follow the principles.Adequate preoperative preparation,appropriate surgery access,carefully and gently operate,appropriate antibiotic use and postoperative management are the key measures to reduce the incidence of complications.