上尿路结石合并肾功能衰竭的微创治疗

Microtraumatic treatment of obstructive renal dysfunction caused by upper urinary stones

目的 探讨上尿路结石合并肾功能衰竭的微创治疗方法.方法 1998年8月～2005年12月,采用输尿管镜下气压弹道碎石取石、置双J管,术后体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL)、经皮肾镜碎石取石术及一期行经皮肾穿刺造瘘,二期行输尿管镜碎石、ESWL或经瘘道碎石取石等微创方法治疗43例上尿路结石并肾功能衰竭.结果 手术时间23～150min,平均47min,住院时间3～20d,平均7.2d.术后2周～3个月肾功能恢复正常者29例;术后3个月12例仍有氮质血症,但肾功能明显改善,血肌酐术前平均712.4μmol/L(326～2882.7μmol/L),术后降至294.6μmol/L(173～532μmol/L);另有2例仍为尿毒症,需长期血液透析治疗.结石清除率88%(38/43),结石残留5例.随访3个月～5年,平均1.5年,43例均无死亡,无脓肾发生,平均血肌酐186.2μmol/L(39.9～933.1μmol/L),结石复发9例.结论 微创治疗在治疗上尿路结石合并肾功能衰竭方面具有创伤小、病人易耐受、安全性好的特点,可根据病人的具体情况选择采用不同的微创治疗方案.

Objective To explore the microtraumatic treatment for obstructive renal dysfunction caused by upper urinary stones. Methods A total of 43 cases of obstructive renal dysfunction caused by upper urinary stones was treated with microtraumatic treatment from August 1998 to December 2005.The treatment included ureteroscopic pneumatic lithotripsy, ureteroscopic double-J catheter placement followed by extracorporeal shock wave lithotripsy(ESWL),percutaneous nephrolithotomy,and primary percutaneous nephrostomy followed by ureteroscopic lithotripsy,or ESWL,or stone removal through the fistula.Results The operation time was 23~150 min(mean, 47 min) and the hospitalization time was 3~20 d(mean,7.2 d).Renal functions recovered to normal within 2 weeks ~ 3 months after operation in 29 cases;different degrees of azotemia remained 3 months after operation in 12 cases,their renal functions were improved significantly,with the serum creatinine levels decreased from 712.4 μmol/L(326~2882.7 μmol/L) preoperatively to 294.6 μmol/L(173~532 μmol/L) postoperatively;uremia remained in the rest of 2 cases and a long-term dialysis was required.The stone clearance rate was 88%(38/43).Follow-up checkups in the 43 cases for 3 months ~ 5 years(mean,1.5 years) found no death or pyonephrosis.The mean serum creatinine was 186.2 μmol/L(39.9~933.1 μmol/L).Recurrence occurred in 9 cases.Conclusions Microtraumatic treatment has advantages of minimal trauma,good tolerance of patients,and satisfactory safety for treating obstructive renal dysfunction caused by upper urinary stones.Different microtraumatic methods can be selected according to patient's condition.