上尿路结石致急性梗阻性肾功能衰竭的处理.docVIP

上尿路结石致急性梗阻性肾功能衰竭的处理 　　[摘要] 目的：探讨上尿路结石致急性梗阻性肾功能衰竭解除梗阻的几种处理方法及其优缺点。方法：回顾分析68例上尿路结石致急性梗阻性肾功能衰竭患者，分别采用B超引导下经皮穿刺肾造瘘、ESWL、输尿管镜下碎石或插管、开放手术处理并比较其并发症。结果：41例肾功能完全恢复，23例肾功能有明显改善，4例肾功能改善不明显或无效，各组间疗效比较无显著性差异，并发症危害以经皮穿刺肾造瘘、输尿管镜下碎石轻或对肾功能危害小。结论：根据患者具体情况选择处理方法，解除肾功能衰竭患者梗阻，以腔内手术及经皮穿刺肾造瘘为佳。 　　[关键词] 结石；上尿路；肾功能衰竭；急性；治疗 　　Upper urinary tract obstruction caused by acute renal failure treatment 　　SUN Fuguang, KANG Deyuan 　　（Department of Urology， the People′s Hospital of Linyi City, Shandong Province, Linyi 276003, China） 　　[Abstract] Objective: To evaluate the upper urinary tract obstruction in acute renal failure several methods to remove the obstruction and its advantages and disadvantages. Methods: Retrospective analyzed of 68 cases of upper urinary tract obstruction caused by acute renal failure cases, respectively B ultrasound-guided percutaneous nephrostomy, ESWL, ureteroscopic lithotripsy, or intubation, open surgery and to compare the concurrent processing disease. Results: 41 cases of renal function recovered completely, 23 patients had significant improvement in renal function, 4 cases of renal function improvement was not obvious or invalid, the group effect was no significant difference in complications in percutaneous nephrostomy harm, ureteroscopy light or under the rubble of small renal damage. Conclusion: The treatment of choice in patients with specific conditions, lifting of patients with obstructive renal failure, the endovascular surgery and percutaneous nephrostomy better. 　　[Key words] Stone; On the urinary tract; Renal failure; Acute; Treatment 　　 　　2005年1月～2008年12月，本院收治上尿路结石致急性梗阻性肾功能衰竭68例，采用不同处理方法处理，现报道如下： 　　1 资料与方法 　　1.1 一般资料 　　本组68例患者，男37例，女31例，年龄24～73岁，平均52岁，病程1 d～3个月，尿石症病史数月至31年不等。全部患者均有肉眼或镜下血尿，27例有脓尿，就诊时无尿或少尿46例，尿量400～1 000 ml/d 15例，恶心、呕吐49例，水肿18例，高钾血症15例。血尿素氮7.8～46.1 mmol/L，血清肌酐204～1 885 μmol/L，其中＞1 000 μmol/L 11例，血红蛋白60～145 g/L，行血液透析13例。KUB及B超检查：结石大小为0.4 cm×0.7 cm～6.5 cm×4.6 cm，双肾结石9例，双输尿管结石11例，双肾结石并双输尿管结石10例，双肾结石合并单侧输尿管结石17例，单肾结石合并双输尿管结石8例，独肾