上尿路结石致急性梗阻性肾功能衰竭的急诊处理

Emergency Surgery for Acute Obstructive Renal Failure Induced by Upper Urinary Calculi

目的:总结急诊处理由上尿路结石引起急性梗阻性肾功能衰竭的经验和处理方法。方法:对51例上尿路结石引起急性梗阻性肾功能衰竭患者急诊处理方法进行回顾性分析,其中32例行双侧一期开放手术取石,8例先行肾穿刺造瘘术,11例行急诊输尿管镜取石。结果:术后全部患者尿毒症症状减轻或消失,血尿素氮(BUN)、肌酐(Cr)均不同程度减低或恢复正常。结论:上尿路结石致急性梗阻性肾功能衰竭患者应争取同期双侧手术取石解除梗阻,对并发严重感染或一般情况差的患者应及早行肾穿刺造瘘术,输尿管结石所致梗阻可行急诊输尿管镜取石解除梗阻。

Objective: To present the experiences and treatment methods of emergency management for the acute obstructive renal fail induced by upper urinary calculi. Methods: 51 cases of acute obstructive renal failure induced by upper urinary calculi were performed emergency managements. 32 cases were treated by emergent open operation, 8 cases by renal puncture fistulization, 11 cases by emergency ureteroscopic lithotripsy. Results: The uremic symptoms of all patients were relived or disappeared after treatments and the serum BUN and Cr levels were decreased in different degrees. Conclusion: Emergency bilateral operation is indicated for acute obstructive renal failure induced by upper urinary calculi, but if associated with severs infection or the patient general condition being poor, earlier renal fistulization is recommended. The obstruction induced by ureter calculi was suggested to perform emergency ureteroseopic lithotripsy.