摘要目的 探讨输尿管镜钬激光碎石术治疗肾盏结石出现液体外渗的相关临床因素及其预防措施. 方法 回顾性分析2005年5月至2009年3月138例经输尿管镜钬激光碎石术治疗肾盏结石患者的临床资料,对患者性别、年龄(＜30岁,30～50岁,＞50岁)、上尿路结石治疗史(ESWL或开放手术)、术前上尿路感染、术中放置输尿管导管和手术时间(＜50 min,50～80 min,＞80 min)与是否出现液体外渗行x2检验,相关因素进一步行二值Logistic回归分析. 结果 术中出现液体外渗24例,其中单纯肾周积液18例、肾周积液合并腹腔积液3例、肾周积液合并腹腔及胸腔积液1例、单纯水中毒2例.患者性别和年龄与是否出现液体外渗无关,而上尿路ESWL或开放手术史、术前上尿路感染、术中未放置输尿管导管和手术时间长均促进液体外渗的发生. 结论 合理选择病例和手术时机、术中常规留置输尿管导管和控制手术时间是减少输尿管镜治疗肾盏结石中液体外渗发生的重要措施.

abstractsObjective To explore the underlying clinical factors and precautionary measures of fluid extravasation in patients with calyceal calculi treated by ureteroscopic holmium laser lithotripsy.Methods A retrospective review was made on clinical records of 138 patients with calyceal calculi receiving retrograde ureteroscopic holmium laser lithotripsy from May 2005 to March 2009. The relevance was studied between the occurance of fluid extravasation complications and various clinical factors using x2 test and binary Logistic regression. The clinical factors included patients' sexes, age groups (＜30 years, 30-50 years, ＞50 years), history of treatment (ESWL or open surgery) for upper urinary tract calculi, preoperative upper urinary tract infection, intraoperative placement of ureteral catheter and the length of procedure duration (＜ 50 min, 50-80 min, ＞ 80 min). Results Fluid extravasation complications occurred in 24 patients. The sexes and age groups were irrelevant to the occurance of fluid extravasation complications; while history of ESWL or open surgery and preoperative infection in upper urinary tract, without intraoperative ureteral catheter placement and long duration of procedure were responsible for the higher rates of the fluid extravasation complications.Conclusion Reasonable selection of patients and timing of operation, regular intraoperative ureteral catheter placement and control the length of procedure duration help to reduce fluid extravasation during retrograde ureteroscopic lithotripsy.