經皮腎臟鏡碎石術併發肋膜腔積水

「經皮腎臟鏡體內碎石術」是治療腎臟結石的有效工具，經由肋骨下進行的方法所產生的併發症比經由肋骨上的方法要少，而且可經由置於工作套的腎臟導管來減少併發症的發生。我們報告了一個在實施「經腎臟鏡體內碎石術」時發生肋膜腔積水的病例。此病例雖然採取經由肋骨下的方式，手術中置放工作套，手術後置放腎臟導管來引流，卻仍然發生此一併發症。本病例報告主要目的是提醒麻醉同仁，雖然「經腎臟鏡體內碎石術」中發生肋膜腔積水的可能性很低，但卻是該種手術中發生缺氧、呼吸道壓力增加的情況時，所需做鑑別診斷的項目之一。
Percutaneous nephrolithotomy (PCNL) effectively treats large stones or stones in the lower renal poles. The complication fate for the subcostal approach is lower than for the supracostal approach, and complications generally can be avoided by using a working (Amplatz) sheath and by inserting a large nephrostomy tube after the procedure. We present the case of a patient who developed a left pleural effusion during a subcostal PCNL for a left renal stone. A working sheath had been used, and a nephrostomy tube had been inserted for drainage and tract tamponade after the procedure. Our report is intended to alert colleagues that even though pleural effusion is a rare complication of subcostal PCNL, it could cause intraoperative high airway pressure and hypoxemia.