超声引导下经皮肾盂穿刺置管引流治疗急性梗阻性肾病

Ultrasound-guided Percutaneous Nephrostomy as an Initial Treatment for Acute Obstructive Nephropathy

目的：研究超声引导下经皮肾盂穿刺置管引流对急性梗阻性肾病的治疗价值。方法：对16例急性梗阻性肾病的19个肾脏进行了超声引导下经皮肾盂穿刺置管引流（良性病变10例，恶性病变6例）。结果：19个肾脏均一次穿刺置管成功，未见严重并发症。所有病例血肌酐（Scr）在置管前后有显著性差异（P〈0．01），其中1～8周内下降最快（P〈0．01），24～48周内下降缓慢（P〉0．05）。随着肾功能的恢复10例良性病变7例择期进行了手术治疗、2例继续引流、1例中止引流；6例恶性病变2例择期进行了手术治疗、3例继续引流姑息治疗、1例于引流置管1年2个月死亡。结论：超声引导下经皮肾盂穿刺置管引流安全、微创，可促进梗阻性肾病肾功能的恢复，为进一步治疗创造有利的条件，也可作为无法手术的恶性肿瘤所致梗阻性肾病的姑息治疗手段。

Objective-To explore the value of percutaneous nephrostomy as an initial treatment for acute obstructive nephropathy by color doppler ultrasound guidance. Methods： 19 renal of 16 cases with acute obstructive nephropathy were subject to percutaneous nephrostomy（ 10 benign cases, 6 malignant cases ）. Results： 19 cases were accomplished one time, no serious complications , the serum creatinine （Scr）has a statistical value after per- cutaneous nephrostomy （P 〈 0.01）. Set in all cases were significant decease withinl - 8 weeks （ P 〈 0.01 ）, but it became slower between 24--48 weeks （P 〉0.05）.with renal functional recovery, 7 of 10 benign cases and 2 of 6 malignant cases had performed operations , another 3 malignant cases were keeping treatment, 1 malignant cases dead by respiratory and cardiac failure after puncture 1 year and 2 month. Conclusions- Ultrasound - guided percutaneous nephrostomy can help renal functional recovery and obtain a chance for operations , moreover, it also as a treatment method for malignant cases , who loss chance of the operation , it is a simple and useful initial method for acute obstructive nephropathy