拔除肾造瘘管相关的“胸膜反应”表现、处理及预防

Objective To summarize the clinical manifestations, emergency management, and prevention strategies of “pleural reaction” triggered by removal of a nephrostomy tube after percutaneous nephrolithotomy with holmium laser lithotripsy(PCNL). Methods A retrospective analysis was conducted on the clinical data of 642 adult patients who underwent ultrasound-guided PCNL in our hospital from January 2018 to December 2024. Five patients who developed “pleural reaction” after nephrostomy tube removal were selected as the study subjects. Their clinical manifestations, treatment processes, and outcomes were analyzed. Results Among the 642 patients, “pleural reaction” occurred in 5 cases after tube removal, with an incidence of 0.78%. Among these 5 patients, there were 4 males and 1 female. 3 cases involved the left side and 2 cases involved the right side. 1 case was complicated by pneumothorax. The main clinical manifestations included stoma site pain, profuse sweating, chest tightness, chest pain, breathing difficulty, and even dyspnea. After symptomatic treatments such as semi-recumbent positioning, oxygen inhalation, and analgesia(diclofenac sodium, tramadol or pethidine), the symptoms were effectively relieved in all 5 patients. The 1 patient with pneumothorax(lung compression>30%) recovered after thoracic puncture aspiration and indwelling central venous catheter drainage. Conclusion The incidence of “pleural reaction” caused by nephrostomy tube removal after percutaneous nephrolithotomy is low, but the clinical manifestations are relatively typical. The condition can be completely managed with timely symptomatic treatment and thoracic drainage(if pneumothorax is present). Preoperative rational planning of the puncture tract, intraoperative accurate positioning, and adoption of lateral decubitus positioning with breath-holding during tube removal are effective preventive measures.