上尿路结石并发重度尿毒症的急症手术治疗

Emergent surgical treatment of calculi of upper urinary tract associated with severe uremia

报告20例上尿路结石并发重度尿毒症患者急症手术治疗结果。18例选择功能较好的一侧切开取石(包括4例孤立肾患者),待病情稳定后再相继处理对侧肾或输尿管结石;2例病情危重者,先行经皮肾穿刺造瘘术,在病情稳定后,又行手术取石。结果18例治愈出院,1例死于手术后电解质紊乱、急性心衰,另1例术后行血液透析,病情好转自动出院。作者对本病的临床表现、手术方式的选择、术后处理以及血液透析在本病症中的适应证作了讨论。

20 patients with calculi of the upper tract associated with severe uremia were treated surgically.Incision was performed on the urinary tracts with betterfunction,and the stones were removed in 18 patients(including four patients with solitary kidney);thecontralateral kidneys and the stones in thecontralateral urinary tracts were not treated until thepatients′condition became stable.In the two critical-ly ill patients,fistulation through percutaneousreno-punctuure was performed first and the surgicaltreatment was given as soon as the patient′s condi-tion became stable.18 patients were cured anddischarged;one patient died of postoperativeelectrolyte disturbance and acute cardiac failure,andone underwent hemodialysis after operation and wasdischarged at the request of the patient when the pa-tient′s condition was improving.The clinical featuresof the patients,the selection of the means of operation,the postoperative treatments and the indication ofhemodialysis in uremia were discussed.