经皮肾镜碎石术后继发肾被膜下积液的影像学表现及诊治分析-东南大学学报医学版

经皮肾镜碎石术后继发肾被膜下积液的影像学表现及诊治分析

单位：1. 济南市人民医院泌尿外科, 山东济南 271199;
2. 济南市人民医院影像科, 山东济南 271199;
3. 济南市人民医院手术室, 山东济南 271199

分类号：R698.2

出版年·卷·期（页码）：2019·38·第四期（591-595）

摘要：

目的：探讨经皮肾镜碎石术后继发肾被膜下积液的影像学表现及诊治方法。方法：回顾分析2014年9月至2018年4月14例在本院行经皮肾镜碎石术后继发肾被膜下积液患者的影像学资料以及临床治疗方法。结果：所有患者均行一期超声引导肾被膜下穿刺引流，4例单纯引流后即治愈，2例行肾被膜下无水酒精硬化剂灌注后治愈，其余8例均行二期经皮肾镜手术，肾被膜与肾盂肾盏打通，留置肾盂造瘘管及肾被膜下引流管，先后拔除肾被膜下引流管及造瘘管后治愈。肾被膜下积液患者的影像学表现为肾脏外形增大，呈梭形、三角形或者月牙形的无回声区。顺、逆行造影均不能发现肾被膜下囊腔与肾盂肾盏相通。对14例患者分别给予穿刺引流、无水酒精等硬化剂灌注以及二期经皮肾镜手术后治愈。随访半年未见复发。结论：对经皮肾镜碎石术后继发肾被膜下积液患者可根据具体病情发展，采用单纯引流、无水酒精等硬化剂注射以及二期经皮肾镜手术治疗。

Objective: To investigate the imaging features, diagnosis and treatment of secondary subcapsular effusion after percutaneous nephrolithotomy. Methods: From September 2014 to April 2018, 14 patients with secondary subcapsular effusion after percutaneous nephrolithotomy in our hospital were analyzed retrospectively in terms of imaging data and clinical treatment. Results: All the patients were treated with one-stage ultrasound-guided subcapsular puncture and drainage, 4 cases were cured after simple drainage, 2 cases were cured after infusing anhydrous alcohol sclerosing agent under the renal capsule, and the other 8 cases were treated with second-stage percutaneous nephroscopic surgery. Renal capsular and pyelonephric calyx were opened, pyelostomy tube and subcapsular drainage tube were indwelled, and then removed subcapsular drainage tube and fistula tube were removed successively. The curative effect of follow-up treatment was followed up. In the patients with subcapsular effusion, the renal shape was enlarged, showing fusiform, triangular or crescent-shaped anechoic areas. Neither anterograde nor retrograde angiography could find that the subcapsular capsule was connected with the renal pelvis and calyx.14 patients were cured by puncture drainage, anhydrous alcohol and other sclerosing agents, and the second stage percutaneous nephroscopic surgery was performed. Follow-up for half a year showed no recurrence. Conclusion: The secondary subcapsular effusion after percutaneous nephrolithotomy can be cured by simple drainage, absolute alcohol injection and secondary percutaneous nephrolithotomy.

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