输尿管镜气压弹道碎石术治疗上尿路结石梗阻性急性肾功能衰竭

Ureteroscopic pneumatic lithotripsy for acute renal failure due to upper urinary calculous obstruction

目的探讨输尿管镜气压弹道碎石术治疗上尿路结石梗阻性急性肾功能衰竭的疗效。方法2002年8月—2006年4月对我院12例（19侧）上尿路结石梗阻性急性肾功能衰竭（血Cr〉443μmol/L）急诊行输尿管镜探查,气压弹道碎石。到达结石处后,使用瑞士EMS气压弹道碎石机击碎并取出结石,对于较大或碎石困难的结石,不求取净结石,快速打通输尿管腔,留置双J管引流。结果12例19侧均一次性打通输尿管腔,留置双J管。9例16侧输尿管结石一次取净;3例3侧肾盂残留少量结石,其中2例口服排石药后自行排出,1例体外冲击波碎石后自行排出。12例未出现输尿管撕脱、断裂、穿孔等严重并发症。12例血Cr术后3-7 d降至正常,肉眼血尿术后1-4 d消失。12例术后3-7 d,平均5 d出院。双J管术后1-2个月拔除。10例随访2-30个月,平均14个月,血Cr正常,彩超或KUB平片无泌尿系结石复发。结论对于上尿路结石梗阻性急性肾功能衰竭的患者,急诊输尿管镜下碎石,疗效确切,创伤小,可同时处理双侧输尿管结石。

Objective To evaluate the curative effect of ureteroscopic pneumatic lithotripsy in the treatment of acute renal failure due to upper urinary calculous obstruction. Methods There were 12 cases （19 sides ） of acute renal failure （serum creatine 〉 443 μmol/L） due to upper urinary calculous obstruction, urgently treated by pneumatic lithotripsy （EMS, Switzerland ） under ureteroscopy, from August 2002 to April 2006 in this hospital. After stone fragmentation and removal, an indwelling double-J stent was placed into the ureter at the same time. Results The continuity of the ureter was restored after one session of lithotripsy in all the 12 cases（19 sides）. The ureteral calculi were thoroughly removed on one session in 9 cases （ 16 sides）. Few residual stones were found in the renal pelvis in 3 cases（ 3 sides ） , in two of which the stones were spontaneously expelled after oral medication, and in another, after extracorporeal shock wave lithotripsy （ ESWL）. No severe complications happended, such as ureteral avulsion, rupture, or perforation. Concentrations of serum creatine were decreased to normal within 3-7 days after operation in all the 12 cases. The gross blood urine disappeared in 1-4 days postoperatively. The patients were discharged from hospital after 3-7 days （ mean ,5 days ） after operation. The double-J catheter was removed at 1-2 months postoperatively. Follow-up examinations in 10 cases for 2-30 months（mean, 14 months） found normal levels of serum creatine and no recurrent urinary stones under ultrasonography or X-ray radiography. Conclusion Ureteroscopic pneumatic lith- otripsy in the treatment of acute renal failure due to upper urinary calculous obstruction is an effective treatment with short operation time , safety, and minimal trauma. By using this procedure, both sides of ureteral stones can be removed on one session.