输尿管镜合钬激光治疗结石性输尿管梗阻并发急性肾功能衰竭.docVIP

输尿管镜联合钬激光治疗结石性输尿管梗阻并发急性肾功能衰竭 　　【摘要】 目的：探讨输尿管镜下钬激光碎石治疗结石性输尿管梗阻所致急性肾功能衰竭的疗效。方法：应用输尿管镜钬激光碎石治疗结石性输尿管梗阻引起的急性肾功能衰竭30例。结果：30例患者均成功解除梗阻，术后肾功能恢复或改善，血清尿素氮、肌酐均恢复正常或接近正常，尿量恢复正常。28例钬激光碎石成功，2例输尿管上段结石部分进入肾盂肾盏，术后体外冲击波碎石，结石顺利粉碎并排出。结论：输尿管镜下钬激光碎石治疗结石性输尿管梗阻并发急性肾功能衰竭，是一种微创、安全而有效的治疗方法。 中国论文网 /6/viewhtm　　【关键词】 输尿管镜； 钬激光； 输尿管梗阻； 急性肾功能衰竭 　　中图分类号 R693.4 文献标识码 B 文章编号 1674-6805（2015）27-0028-02 　　【Abstract】 Objective：To evaluate the clinical efficacy of ureteroscopic holmium laser lithotripsy in the treatment of acute renal failure due to ureteral stones obstruction.Method：30 patients with acute renal failure caused by ureteral stones obstruction were treated with transurethral ureteroscopic holmium laser lithotripsy.Result：The obstruction of 30 cases were released completely.Renal function return to normal or near normal after treatment，blood urea nitrogen and creatinine are back to normal or near normal，urine volume of patients return to normal.Successful lithotripsy were made in 28 cases immediately.Few residual stones were founded in the renal pelvis in 2 case.The residual stones were spontaneously expelled after extracorporeal shock wave lithotripsy（ESWL）.Conclusion：Ureteroscopic holmium laser lithotripsy is a minimally invasive，safe and effective treatment methods for acute renal failure due to ureteral stones obstruction. 　　【Key words】 Ureteroscopy； Holmium laser； Ureter obstruction； Acute renal failure 　　First-author’s address：The Hospital Affiliated to Putian University，Putian 351100，China 　　doi：10.14033/j.cnki.cfmr.2015.27.013 　　笔者所在医院2009年1月-2014年5月采用急诊输尿管镜下钬激光碎石术治疗结石性输尿管梗阻并发急性肾功能衰竭30例，效果满意，现报告如下。 　　1 资料与方法 　　1.1 一般资料 　　本组患者30例，男18例，女12例，年龄22～65岁，平均42岁。双侧输尿管结石梗阻23例，解剖及功能性孤立肾合并输尿管结石梗阻7例。本组病例均行急诊B超、泌尿系平片（KUB）、静脉肾盂造影或者CT检查明确诊断。其中少尿21例，尿量100～150 mL，无尿9例。血尿素氮16～35.7 μmol/L，平均25.5 μmol/L。血肌酐375～1410 μmol/L，平均868 μmol/L，23例血钾≥5.5 mmol/L，7例血钾正常。结石大小横径0.7～1.0 cm，纵径0.6～1.8 cm，均有不同程度的肾盂积水。 　　1.2 治疗方法 　　应用Germany wolf F7/8.9硬性输尿管镜、Germany wolf液压推注泵、Japan Olympus视频监控系统以及美国Lumenis科医人医疗激