ESWL治疗单侧输尿管结石致肾形态缩小18例分析

Analysis on 18 cases of renal diminution caused by ESWL in treating monolateral ureteral calculus

目的探讨输尿管结石行体外冲击波碎石术(ESWL)治疗后肾实质萎缩、远期肾形态缩小的相关因素。方法 2007年1月—2010年5月于我院行ESLW治疗单侧输尿管结石495例,术后随访6～18月,根据术前肾积水程度、结石在输尿管位置、结石在输尿管内停留时间分别分组,将各组出现肾实质萎缩肾形态缩小的情况进行比较分析。结果术后肾缩小率中度积水组大于轻度积水组、下段结石组大于上、中段结石组、结石停留时间超过3个月者组大于3个月组(均P<0.05)。结论 输尿管结石引起的中度肾积水患者行ESWL前应充分评估肾功能损害情况。避免因ESWL加重输尿管水肿而出现急性梗阻,导致肾实质萎缩,远期肾形态缩小。因此输尿管结石引起的肾中度积水的患者应尽量选择腔内碎石或手术取石。如选择ESWL术前应放置双J管并合理用药,以达到尽早通畅引流、预防肾内感染,减少肾实质萎缩及远期肾形态缩小。

Objective To analyze the correlative factors of renal atrophy and long-term renal diminution caused by ESWL in treating ureteral calculus.Methods 495 cases of monolateral ureteral calculus who received ESWL in our hospital from January 2007 to May 2010 and followed up for 6-18 months were grouped according to the degree of preoperative hydronephrosis,location of ureteral stone and residence time of ureteral stone.The condition of renal atrophy and renal diminution occurring in each group were compared.Results Postoperative renal diminution rate was higher in mid-degree hydronephrosis group than in mild hydronephrosis group,it was also higher in low ureteral stone group than in upper,middle ureteral stone groups and residence time of ureteral stone more than 3 months group（all P0.05）.Conclusion The condition of renal dysfunction should be adequate assessment before patients with mid-degree hydronephrosis caused by monolateral ureteral calculus undergoing ESWL,to avoid acute obstruction,renal atrophy and long-term renal diminution because of hydronephrosis aggravated by ESWL.Whatever,the double-J tube should be put in before ESWL in order to achieve easily drainage and to prevent renal infection,renal atrophy and long-term renal diminution.