第五十六章泌尿系统梗阻张建春.ppt

* * The First Hospital of Xinxiang Medical College * * The First Hospital of Xinxiang Medical College 适应证:上尿路结石,结石直径0.5～2.5cm，无全身出血性疾病，输尿管远端无梗阻。 禁忌证： 　绝对禁忌证：妊娠妇女、结石远端尿路梗阻 　相对禁忌证：凝血功能障碍、少尿性器质性肾衰、急性尿路感染、严重心脑血管病、结石体积过大者等。 * * The First Hospital of Xinxiang Medical College 并发症 血尿：碎石后多数病人出现暂时性肉眼血 尿，一般不须处理。 肾绞痛：碎石排出过程可引起肾绞痛。 感染：感染性结石碎石后可引起尿路感染、发热等。 “石街”形成：碎石过多地积聚于输尿管内，病人腰痛不适，若不及时处理，可合并梗阻、继发感染导致肾功能丧失。 肾及其周围脏器损伤：虽然少见，但应十分重视和防止。 * * The First Hospital of Xinxiang Medical College 采用ESWL治疗时，要严格选择病人，正确定位，选用低能量和限制每次冲击次数，并重视碎石后的处理措施，以提高疗效、减少并发症的发生。若需再次治疗，间隔时间必须不少于1周，碎石次数不超过3次！ * * The First Hospital of Xinxiang Medical College 腔内泌尿外科： 输尿管镜取石或碎石术(ureteroscopic lithotomy or lithotripsy） 经皮肾镜取石或碎石术(Percutaneous nephrostolithotomy，PCNL) * * The First Hospital of Xinxiang Medical College 输尿管镜碎石、套石术 * * The First Hospital of Xinxiang Medical College * * The First Hospital of Xinxiang Medical College 软性输尿管肾镜取石术 * * The First Hospital of Xinxiang Medical College 经皮肾镜取石或碎石术(PCNL) * * The First Hospital of Xinxiang Medical College 经皮肾镜取石或碎石术PCNL * * The First Hospital of Xinxiang Medical College 双侧输尿管结石：先取梗阻严重侧 一侧肾结石、一侧输尿管结石：先处理输尿管结石 双肾结石： 总肾功能良好：先取肾功能较差的一侧 总肾功能不好：先改善肾功能，再取功 能较好一侧的结石 双侧上尿路结石的治疗原则 * * The First Hospital of Xinxiang Medical College * * The First Hospital of Xinxiang Medical College 形成尿结石的物质排出增多 尿PH改变 尿量减少，使盐类和有机物质的浓度增高。 尿中抑制晶体形成和聚集的物质减少。 尿路感染时尿基质增加，使晶体粘附，形成结石。 * * The First Hospital of Xinxiang Medical College 结石引起的肾盂肾盏积水 * * The First Hospital of Xinxiang Medical College 结石引起的肾盂肾盏积水 * * The First Hospital of Xinxiang Medical College 结石引起的肾盂肾盏积水 * * The First Hospital of Xinxiang Medical College 结石引起的肾盂肾盏积水 * * The First Hospital of Xinxiang Medical College 结石引起的肾盂肾盏积水 * * The First Hospital of Xinxiang Medical College 结石引起的肾盂肾盏积水 * * The First Hospital of Xinxiang Medical College 结石引起的肾盂肾盏积水 * * The First Hospital of Xinxiang Medical College * * The First Hospital of Xinxiang Medical College * * The First Hospital of Xinxiang Medical College The First Hospi