5例输尿管结石导致肾积液临床研究.docVIP

5例输尿管结石导致肾积液临床研究【摘要】 目的 提高输尿管结石导致肾重度积液临床诊治水平。方法 对5例病例的分析，更加明确输尿管结石导致肾积液的形成机制，临床表现，诊断方法和治疗效果。结果 5例患者治疗成功5例，其中一例曾导致肾积脓，经畅通输尿管后病员均痊愈出院。2例病员术前B超检查示，肾实质菲薄，并且ECT证实病变肾无肾功，采取肾切除术(术前检查对侧肾功能正常)。结论 输尿管疾病导致的尿流不通主要是影响肾脏的功能，可能危及全身和患者的生命。? 【关键词】 输尿管结石；导致积液；临床分析 Five clinical analysis of renal severe effusion cause by ureteral calculus HE Xin?quan. Shiban center hospital,Jianyang city,Sichuan province,641413,China ? 【Abstract】 Objective Improvement of the clinical treatment for renal severe effusion cause by ureteral calculus. Methods the analysis of five patient cases makes it more clearly as Formation mechanism, clinical manifestations, diagnostic methods, therapeutic effect. Results Five patients all have been cured and left hospital. One in five was contracted with pyonephrosis in the process, and has been cured by clearing the ureter. Two have been revealed of renal parenchymal thinning by Ultra?sound B, and pathological changes and renal malfunction have been verified by ECT before surgery. So Nephrectomy has been given under the circumstances (the contralateral renal was tested normal before surgery.) Conclusion Urethral diseases caused by urinary flow barrier is mainly affect kidney function, may endanger the whole body and the life of the patient.? 【Key words】 Ureteral calculus；Cause effusion；Clinical analysis 输尿管结石90%以上在肾内形成，然后降入输尿管的任一位置。并且输尿管有三个狭窄部，其直?从上到下分别为2 mm,3 mm和1~2 mm。输尿管由上到下，管壁越来越厚。输尿管结石如不能排出，无论大小，都可引起肾积水，造成肾功能损害，因此如结石不能顺利排出，就需要外科干预。本文就我科近一年来5例输尿管结石导致肾重度积液而行手术的治疗临床资料作回顾性分析，现报告如下。 1 资料与方法 1.1 一般资料 5例患者均为女性，年龄35~70岁。单侧结石4例，双侧结石1例，结石部位均为输尿管中下段。5例病员均为肾重度积液，其中一位为肾积脓，有2例导致肾重度积液，术前B超示肾实质菲薄，ECT证实患肾无肾功能。 1.2 临床资料 5例病员均未诉典型之肾绞痛史，平时只自诉腰部胀痛不适。其中一例病员病史长达5年，但均按骨质增生治疗，在常规B超检查时发现输尿结石伴肾积液，手术证实积液为积脓。5例病员术前均常规行肾静脉肾盂造影和ECT检查肾功，但因条件所限，未行细菌培养和药敏试验，尿钙、尿磷、尿镁测定。 1.3 治疗及手术方法 患者一经确诊，积极完善相关术前检查，择期在持硬麻醉下行患侧尿路探查术。切口5例中有1例下腹部斜切口，余4例为腰部斜切口。有2例行患侧肾脏切除术，余3例为输尿管切开取石，输尿管内引流术。5例均术后痊愈出院，术后随诊无特殊。 2 讨论 2.1 输尿管结石导致肾结液概术 输尿管结石两侧发病数大致相等，双侧者均约占5%，并且结