急诊输尿管镜钬激光碎石一期治疗双侧输尿管结石并急性肾功能衰竭(附23例报告)

Emergent operation of one-session ureteroscopic holmium lithotripsy for bilateral ureteral calcali combined with acute renal failure(report of 23 cases)

目的探讨急诊输尿管镜钬激光碎石一期治疗双侧输尿管结石并肾衰的安全性和疗效。方法23例双侧输尿管结石并肾衰患者均行输尿管镜钬激光碎石一期治疗双侧输尿管结石,术后双侧输尿管均留置双J管。结果23例碎石术后均能立即解除双侧输尿管梗阻,无严重手术并发症发生。术后1周肾功能完全恢复正常者20例(86.9%);术后4～6周复查KUB及B超全部患者排尽结石;其余3例碎石术后6个月肾功能仍未恢复但有改善。全部患者术后3个月IVU检查均显示双侧输尿管通畅。结论双侧输尿管结石并急性肾衰患者选择输尿管镜钬激光双侧输尿管一期碎石治疗是一种适宜的腔内手术方法,创伤少,手术时间短,操作简单,安全有效,值得临床推广。

[Objective] To discuss the efficacy and safety of emergent operation of one-session ureteroscopie holmium lithotripsy for bilateral ureteral calcali combined with acute renal failure. [Methods] 23 cases of bilateral ureteral calcali combined with acute renal failure were treated by ureteroscopic holmium lithotripsy in one-session emergent operation. Double-J tubes were placed into bilateral ureters after operation. [Result] In all the patients one-session ureteroscopic holmium lithotripsy was successful in treating bilateral ureteral calcali. The obstruction of bilateral ureters was removed soon after operation and no serious complication appeared. KUB X-ray and B ultrasound of all the patients showed stone free at 4-6 Weeks postoperatively. Renal function returned to normal in 20 cases （86.9%） 1 week postoperatively. Renal function of the remaining 3 cases was improved 6 months postoperatively. IVP of all the patients showed bilateral ureteral unobstructed 3 months postoperatively. [Conclusion] Emergent operation of one-session ureteroscopic holmium lithotripsy is safe and effective in managing bilateral ureteral calcali combined with acute renal failure. This procedure is the most appropriate, less time-consuming and minimally-invasive. It is worth applying widely to all the patients who suffer from bilateral ureteral callcali and renal failure.