输尿管镜治疗结石引起的急性梗阻性肾功能衰竭

Ureteroscopy for the treatment of acute obstructive renal failure resulted from upper ureteral calculi

目的：探讨急诊应用输尿管镜治疗上尿路结石引起急性梗阻性肾功能衰竭的价值。方法对123例双侧上尿路结石梗阻导致急性肾功能衰竭患者均经输尿管镜下探查、气压弹道碎石取石、置管及经皮肾造瘘引流等微创治疗。结果100例（81．3％）术后2～10天BUN、Cr降至正常；22例术后10～15天Cr仍在188.6～232.3iμmol／L，1例因一侧先天独肾对侧输尿管结石慢性梗阻引起肾功能衰竭，术后3天血液透析1次，术后15天Cr810μmol／L，出院2个月Cr正常。4例因一侧肾切除或一侧先天独肾等对侧肾功能差，3个月复查仍处于氮质血症期。结论：使用输尿管镜急诊治疗结石梗阻性肾功能衰竭能及时解除梗阻，有效保护肾功能，损伤小，并发症少，操作简单，可以作为首选方法使用。

Objective To investigate the advantages of emergent ureteroscopy for the treatment of acute obstructive renal failure resulted from upper ureteral calculi. Methods A total of 123 cases of acute renal failure caused by bilateral upper ureteral calculi was treated with ureteroscopic exploration, ballistic lithotripsy, catheter indwelling, and percutaneous nephrolithotomy. Results The serum BUN （blood urea nitrogen） and Cr （creatinine） were decreased to normal levels 2 ～10 days after operation in 100 cases （81.3%） ; the levels of Cr were maintained at 188.6 ～ 232.3 μmol/L 10～ 15 days after operation in 22 cases. In 1 case of congenital solitary kidney （renal failure caused by chronic contralateral ureteral calculous obstruction） , a hemodialysis was needed on the 3rd day after operation, and the serum Cr was 810 μmol/L on the 15th day after operation and was dropped to normal after 2 months postoperatively. In 4 cases of previous unilateral nephrectomy or congenital solitary kidney, azotaemia remained at 3 months after operation. Conclusions Emergent ureteroscopy for acute renal failure caused by calculous obstruction possesses advantages of immediate obstruction relief, effective renal function protection, little trauma, low complication rate, and simole oerformance.