输尿管镜治疗上尿路结石并急性肾衰的临床观察.DOCVIP

临床医学论文-输尿管镜治疗上尿路结石并急性肾衰的临床观察 【关键词】? 输尿管 ??? 摘 要：目的：探讨上尿路结石性梗阻并急性肾功能衰竭（ARF）的治疗方法。方法：1998年3月至2003年6月间对26例30次输尿管结石应用输尿管镜直视下行气压弹道碎石治疗，并置入双“J”管内引流治疗的临床资料进行回顾性总结。结果：26例患者30次手术后均很快出现多尿，BUN及Cr均恢复正常或接近正常，结石排净率93.3%（28/30）。结论：对输尿管结石嵌顿并发ARF患者，采用输尿管腔内手术治疗，采用碎石、取石，置入双“J”管内引流，可以立即解除输尿管梗阻，恢复排尿，改善肾功能。具有安全有效、损伤少的优点，能同时处理双侧输尿管内不同部位病变，可作为首选的方法。 ??? 关键词：? 输尿管结石；?? 急性肾功能衰竭；??? 输尿管镜；?? 碎石术 ??? Ureteroscopic Manipulation for the Treatment of Acute Ureteral Calculous Obstruction? Associated? with Acute Renal Failure ?????? Abstract: Objective: To evaluate the treatment value of ureteroscopy in bilateral upper urinary tyact stones obstruction with acute renal failure.?Method: Clinical data of patients with acute uroterolith obstruction with complicating ARF from Mar.1998 to Jun.2003 were reviewed retrospectively 26 cases were treated by mergency lithotipoy with ballistic lithoclast under ureteroscopicy and indwelling double J tube. Result: Most of the uremia symptoms were reduced or dissolved postoperatively.All patients serum BUN,Cr levels decreasted in different degree or return to normal stone-牋牋牋?free rates were up to 93.3%(28/30).?Conclusion: The ureteroscopic procedure manipulation is claimed to be a safe less trauma.easily and effective for the treatment of ureterolith with complicating acute renal failure. Which can treat the bilateral ureter stones simultaneously. ??? Key words：????? Ureteral calculi；????? Acute renal failure；????? Ureteroscopoy；????? Lithotripsy ??? 我院自1998年3月至2003年6月共收治输尿管结石嵌顿并ARF共26例，均采用输尿管镜下气压弹道碎石术，疗效满意，现报告如下。 ??? 1 资料与方法 ??? 1.1 一般资料：本组26例，男15例，女11例。年龄30～80岁，平均59.1岁。双侧输尿管结石11例，先天性独肾对侧输尿管结石3例，1侧肾切除后对侧输尿管结石嵌顿5例，1侧肾无功能对侧输尿管结石嵌顿7例。其中输尿管中下段结石22例，上段结石8例。本组病例无尿12例，其中无尿24h5例，36h4例，72h3例。少尿14例，少尿时间为5～10d，尿量为200～600ml/d,血尿素氮（BUN）26.1～48.32mmol/L,平均32.3mmol/L;血肌酐（Cr）340～1500μmol/L,平均950μmol/L;高血钾8例，最高达6.2mmol/L;高血压7例，最高达220/130mmHg。全部病例有不同程度全身水肿、贫血、肾绞痛、血尿及恶心呕吐。KUB阳性结石者16例，阴性结石8例，2例间有排石史。B超检查26例均有不同程度肾积水，积水直径3.5ml共6例。同期对照组21例输尿管结石梗阻并急性肾功能衰竭患者，均采用急诊输尿管切开取石治疗。 ??? 1.