上尿路梗阻性急性肾功能不全内、外引流的选择

The Selection of Double J Tube Internal Drainage or Percutaneous Nephrectomy External Drainage in the Treatment of Upper Urinary Tract Obstruction Complicated with Acute Renal Failure

目的探讨内、外引流在上尿路梗阻急性肾功能不全时的选择和效果。方法25例各种原因引起的上尿路梗阻(15例肿瘤性梗阻,10例非肿瘤性梗阻)合并急性肾功能不全,分别或先后对12例行输尿管内置双J管(doub le J,D J)内引流15次,对19例行经皮肾穿刺造瘘(percutaneous nephrectomy,PCN)外引流23次。结果引流成功23例,PCN外引流成功率86.9%(20/23),双J管内引流成功率60.0%(9/15),PCN术后继发出血1例。结论对于盆腹腔进展期或广泛转移肿瘤导致的梗阻,PCN解除梗阻优于输尿管支架内引流;非肿瘤性梗阻宜先尝试D J内引流。

Objective To explore the selection and clinical effects of internal or external drainage for upper urinary tract obstruction complicated with acute renal failure. Methods A total of 25 cases of upper urinary tract obstruction complicated with acute renal failure were treated with double J （D J） tube internal drainage （12 cases, 15 times） or percutaneous nephrectomy （PCN） external drainage（ 19 cases, 23 times）. 15 cases of obstruction were induced by tumor and 10 cases of obstruction induced by benign disease. Results The drainage treatments were performed successfully in 23 cases, with the success rate of PCN and DJ drainage being 86.9% （20/23） and 60.0% （9/15） , respectively. Postoperative bleeding occurred in 1 patient with PCN. Conclusions PCN is superior to DJ in the treatment of malignant obstruction, but DJ internal drainage may be the first choice for non-malignant obstruction.