微创技术治疗孤立肾上尿路结石所致急性肾衰

Mini-traumatic treatment for the acute renal failure of solitary kidney induced by upper urinary calculi

目的探讨孤立肾上尿路结石致急性肾功能衰竭的微创处理方法。方法对56例孤立肾上尿路结石致急性肾功能衰竭患者的资料进行回顾性分析。急诊行B超引导下经皮肾穿刺造瘘10例;输尿管逆行插管引流成功12例,失败2例;输尿管镜下气压弹道碎石成功31例,失败1例。结果发生梗阻72h内解除梗阻的49例患者在3～12d内血Cr由235～869μmol/L降至62～125μmol/L;血BUN由9.9～40.6mmol/L降至2.8～6.8mmol/L;尿量增加,肾功能恢复,临床症状消失。结论KUB和B超检查是首选诊断方法。孤立肾上尿路结石梗阻致急性肾功能衰竭的处理原则是早期诊断,尽早解除梗阻,有效防治并发症,最大限度地保护肾功能。微创技术是孤立肾上尿路结石梗阻的主要处理手段。输尿管逆行插管是最简单的方法,适用于基层医院。输尿管镜下碎石是孤立肾输尿管下段结石梗阻的首选治疗方法,适用于有条件的医院。

[Objective] To explore mini-traumatic treatment for the acute obstructive renal failure of solitary kidney induced by upper urinary calculi. [Methods] Clinical data of 56 cases was analysed retrospectively. 10 cases were treated with percutaneous nephrostomy drainage （PCN）, 12 cases with indwelling ureteral stent retrogradely and 31 cases were treated by transurethral ureteroscopy ballast lithotrity. [Results] In 49 cases treated in 72 hours after obstruction, the serum Cr level decreased from 235-869 umol/L to 62-125 umol/L; the serum BuN level decreased from 9.9-40.6 mmol/L to 2.8-6.8 mmol/L after treatment and renal functions were reserved. [Conclusions] KUB and B typed ultrasonography were the first choices of diagnostic measures. The principles of management should be prompt diagnosis early, release of obstruction as soon as possible, prevention comphcation effectively and to reserve renal functions. Mini-traumatic treatments are major measures for such patients. Indwelling ureteral stent retrogradely is the most simple treatment for basic level hospital. Transurethral ureteroscopy lithotrity should be recommended as the first choise of emergent treatment for patients with obstructive solitary renal failure induced by lower ureteral stones.