Podium 01
經皮腎造廔取石術後之肺栓塞的病例報告
謝棨圳1、 黃琮懿2
1高雄醫學大學附設中和紀念醫院泌尿部
2博田國際醫院泌尿科
Pulmonary Embolism After Percutaneous Nephrolithotomy: A Case Report
Chi-Chun Hsieh1, Tsung-Yi Huang2
1Department of Urology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
2Department of Urology, Park One International Hospital, Kaohsiung, Taiwan
Abstract
Background
PCNL (percutaneous nephrolithotomy) is a standard treatment of renal stone in current guideline. Complications after PCNL include hemorrhage, urinary tract infection, pleural effusion, formation of pseudo-aneurysm and bowel injury. We report a rare case diagnosed as pulmonary embolism after mini-PCNL (mini percutaneous nephrolithotomy).
Cases Presentation
A 73-year-old female with past history of arrhythmia without medication use, diabetes mellitus and hypertension. Bilateral renal stones were noted accidentally. She received left mini-PCNL for left complete staghorn stone under prone position. The operation course was smooth and no acute complication. Total operation time was around 160 minutes with blood loss near 20 ml. She complained SOB (shortness of breath) and chest tightness on post-operative day 1. Desaturation was soon noted and she was then intubated. Chest CTA (computed tomographic angiography) was arranged and revealed pulmonary embolism. EKOS (minimally invasive system for dissolving thrombus), urokinase and heparin were used during stay at intensive care unit. Fortunately, the patient was discharged 3 weeks after the operation.
Conclusion
Surgery is thought to be a risk factors for pulmonary embolism due to vascular endothelium damage. Complications of surgery like pulmonary embolism need to be kept in mind even though performing minimally invasive surgery like mini-PCNL. Patient with higher risk is considered for further evaluation before operation.