经皮肾穿刺治疗梗阻性肾积水32例临床分析

The clinical analysis of 32 patients with hydronephrosis obstruction through percutaneous punction.

目的探讨经皮肾穿刺治疗梗阻性肾积水的临床效果。方法32例梗阻性肾积水患者,根据病情,采用经皮肾穿刺造瘘引流、球囊扩张狭窄处输尿管并留置双J管内引流等方法进行治疗。结果12例患者行输尿管狭窄处球囊扩张治疗后留置双J管,其中1例先天性肾盂输尿管连接部狭窄的患者和9例输尿管手术后吻合口狭窄的患者获得治愈,1例吻合口狭窄的患者再发狭窄行开放手术治疗,2例腹腔肿瘤压迫的患者,1例获得手术治疗,1例失去手术时机,保留肾造瘘管作姑息处理;20例输尿管结石合并感染和肾功能不全的患者,行肾穿刺造瘘引流2周后,均获得手术治疗。结论经皮肾穿刺治疗梗阻性肾积水是一种简单有效的方法,可结合临床患者的具体情况,作为外科手术治疗的有效补充。

Objective To evaluate the therapeutic efficacy of percutaneous puncture in the treatment of obstructive hydronephrosis. Methods Thirty-two patients with hydronephrosis were treated with external drainage, stricture dilatation and double ＂J＂ tube drainage. Results The stricture of urine in 12 of the 32 patients with ureterostenoma were dilated by sacculus and placed with double ＂J＂ tube. Among the 12 patients, 1 with stricture of pyeloureteric junction and 9 with stricture of the anastomotic stoma were cured well （One patient with stricture of the stoma received re- operation because of the recurrence after removing double ＂J＂ tube） ; One of the other 2 patients with oncothlipsis from the abdominal cavity won opportunity of operation after drainage, and the another 1 retained the drainage tube just as alleviative treatment. All of the 20 patients with ureterolith concurrent infection and renal insufficiency obtained operation after draining for 2 weeks. Conclusion Percutaneous renal puncture is a simple and effective manipulation to treat obstructive hydronephrosis, and that is a utility supplement for operation in some conditions.