腔内技术处理急性梗阻性肾功衰竭

Emergency Treatment of Obstructive Acute Renal Failure By Means of Endoscopic Manipulation

目的探讨输尿管镜检、气压弹道碎石、留置双J管等腔内技术，在急诊处理梗阻性急性肾衰中的作用。方法梗阻性急性肾衰患者345例，平均年龄57岁。血尿素氮（BUN）15．2—58．6mmoL／L，血清肌酐（SCr）515。2120μmoL／L，急诊行腔内技术治疗。术后随访1～9个月，追踪测定BUN、Scr。结果345例疗效满意。无腔内手术失败病例。术后24h尿量2200-5800mL，BUN、Scr明显降低，氮质血症逐渐缓解：术后2周肾功能恢复正常285例，60例Scr降至200μmol／L左右。结论腔内技术创伤小、安全可靠、可同时处理双侧输尿管梗阻，患者术后恢复快，在处理梗阻性急性肾衰中有重要作用。

Objective To evaluate endoscopic mainpulation such as ureteroscopy, air- pressure lithotripsy and double J catheter placing for the emergency treatment of obstructive acute renal failure（OARF）. Methods 345 case of obstructive acute renal failure, with an average age of 57, were treated by instant endoscopic manipulation. Blood uria nitrogen（BUN） before treatment was 15.2 - 58.6 mmol/L and serum creatinine （SCr） 515 - 2120 umol/L.The patients were followed up for 1 - 9 naonths. Results Satisfactory result has been observed in all.24 h urine out reached 2200 - 5800 mL with BUN and SCr dropped significantly. Normal renal function has been regained in 285 whereas SCr dropped to 200 umol/L in the other 60 patients. Conclusion Endoscopic management has the advantages of minimal invasion, safty, quick recovery and hilateral ureteral obstruction could be dealt with simultaneously. Instant endoscopic management plays an important role in the treatment of obstructive acute renal failure.