输尿管镜在婴儿肾结石合并急性肾后性肾功能衰竭手术治疗中的应用

Clinical application of ureteroscope in the treatment of infant renal calculus with acute post-renal failure

目的探讨输尿管镜在婴儿肾结石合并急性肾后性肾功能衰竭手术中的临床应用。方法双肾结石合并急性肾后性肾功能衰竭患儿13例。男11例，女2例。年龄5～12个月，平均9个月。其中双肾结石并肾积水5例，一侧肾结石合并对侧输尿管结石嵌顿3例，双侧输尿管结石嵌顿3例，双肾结石合并肾积水伴尿道结石2例。无尿1～3d者11例，少尿5～10d者2例。实验室检查血BUN及SCr均高于正常，高尿酸血症8例，高血钾症9例。13例尿pH均〈6．5，平均5．5。KUB检查均未见阳性结石。B超检查13例均有不同程度肾积水，9例肾积水直径〉2．5cm。CT检查结石直径0．5～1．5cm。均未行透析治疗。13例均行输尿管镜下溶石、碎石、置入双J管内引流术治疗。结果13例患儿术后24h内出现多尿，出现多尿期平均时间为术后12h，多尿期持续24～72h，24h尿量约800-2500ml，术后48～96h尿量逐渐恢复正常。术后1～5d BUN及SCr均恢复正常，8例高尿酸血症患儿术后1～7d血尿酸恢复正常，9例高钾血症患儿术后1～3d血钾恢复正常。13例患儿留置双J管2～4周，复查B超，结石排净11例、结石变小2例。结论对。肾结石合并急性肾后性。肾功能衰竭婴儿应用输尿管镜下腔内手术治疗，采用溶石、碎石，置入双J管内引流，可立即解除上尿路梗阻，恢复排尿，改善肾功能。具有安全有效、损伤小的优点，可作为婴儿肾结石合并急性肾后性肾功能衰竭手术解除梗阻的首选方法。

Objective To investigate the clinical application of ureteroscope in the treatment of infant renal calculus with acute posvrenal failure. Methods Thirteen cases of infant renal calculus with acute post-renal failure included 11 males and 2 females aging from 5 months to 1 years with a mean age of 9 months. Five cases showed bilateral renal calculi with hydronephrosis, 3 cases showed one side renal calculus with contralateral uretal calculus incarceration, 3 cases showed bilateral uretal calculus incarceration, 2 cases showed bilateral renal calculi and hydronephrosis with urinary calculi. Anuria appeared in 11 cases for 1-3 d while oliguria appeared in 2 cases for 5-10 d. BUN and SCr were higher than normal level in all cases. Hyperuricemia was found in 8 cases, hyperkaliemia was found in 9 cases, pH values in urine of all infants were less than 6.5（mean, 5.5）. Radiopague stone was not found in all cases by KUB. Hydronephrosis was found in 13 cases, and the diameter of hydronephrosis in 9 cases was more than 2. 5 cm by B ultrasound. All cases were diagnosed as urinary stones with the diameter from 0.5 to 1.5 cm by CT. All cases were inserted with double J stents under ureteroscope for internal drainage, crushing, rinsing and eliminating stones. Results Hyperdiuresis emerged within 24 h after operation in 13 patients. The duration of hyperdiuresis was from 24 h to 72 h. Urine volume revived gradually 48-96 h after operation while BUN and SCr revived 1-5 dafter operation. Serum uric acid revived 1-7 d after operation in 8 cases of hyperuricacidemia. Serum potassium revived 1-3 d after operation in 9 cases of hyperpotassaemia. Double J tubes were detained for 2-4 weeks. Renal calculus in 10 cases were found by B ultrasound to be discharged and consequently double J tubes were pulled out. Renal calculi in 2 cases became smaller and lighter. Conclusions For infant renal calculus with acute post-renal failure, upper urinary obstruction could be relieved immediately with revived urination and improved renal function by dissolution and crushing of calculus, and the placement of double J tube for internal drainage under ureteroscope. This operation is safe, high-efficient with less lesion, and would be the first option to relieve obstruction for infant re nal calculus with acute post-renal failure.