上尿路结石致急性梗阻性肾功能衰竭的微创处理

Minimally invasive management of acute obstructive renal failure caused by upper urinary calculi

目的探讨利用微创技术治疗上尿路结石致急性梗阻性肾功能衰竭的可行性及临床效果。方法自2005年5月至2010年8月,对60例上尿路结石致急性梗阻性肾功能衰竭患者行微创技术治疗,其中32例先行输尿管置管或经皮肾穿刺造瘘,依据病情行输尿管镜取石术或经皮肾镜取石术等微创方法治疗。结果所有患者均成功解除尿路梗阻,输尿管镜取石术组结石取净率98%,经皮肾镜取石术组结石取净率94%,无严重并发症发生。术后3～14d复查,血Cr由265～1142μmol/L降至68～352μmol/L。术后1个月肾功能恢复正常者52例,8例仍有氮质血症,但肾功能明显改善。结论利用微创技术治疗上尿路结石致急性梗阻性肾功能衰竭具有微创、安全、效果好等优点。

Objective To investigate the feasibility and clinical effect of minimally invasive tech- nique for treating acute obstructive renal failure caused by upper urinary calculi. Methods From May 2005 to April 2010, the data of 60 patients with acute obstructive renal failure caused by upper urinary calculi who underwent minimally invasive management were reviewed retrospectively. Of 60 cases, 32 cases underwent dwelling ureteral stent or percutaneous nephrostomy （PCNL） in the first period , then ac- cording to specific conditions, respectively received ureteroscopic holmium laser lithotripsy （URL） or per- cutaneous nephrostomy （PCNL）. Results All of the patients were treated successfully. The stone-free rate of URL was 98% in patients with middle and lower ureteral calculi, the stone-free rate of PCNL was 94%, no ureteral perforation and other complications were recorded. In 60 cases, the serum Cr level de- creased from 265-1142μmol/L to 68-352 μmol/L postoperative of 3 to 14 days. Renal functions recov- erod to normal within 1 month after operation in 52 cases, different degrees of azotemia remained within 1 month after operation in 8 cases,their renal functions were improved significantly. Conclusions Mini- really invasive technique is a safe and effective method for the treatment of upper urinary calculi compli- cated with acute obstructive renal failure, and should be an alternative way for acute obstructive renal failure caused by upper urinary calculi .