微创腔内技术在上尿路梗阻性肾衰的应用

Application of Upper Urinary Tract Obstructive Renal Failure by Minimally Invasive Endoscopic Technology

目的总结微创腔内技术在不同病因引起上尿路梗阻性肾衰的应用。方法针对49例上尿路梗阻性肾衰,其中上尿路结石34例,各种原因引起输尿管狭窄15例。采用输尿管镜下碎石、狭窄气囊扩张、留置双“J”管、微通道经皮肾镜碎石、肾造瘘等手段治疗。结果49例均成功解除梗阻。急性梗阻37例血BUN、Scr恢复正常范围,最快1 d,最慢25 d。慢性梗阻5例肾功能完全恢复,平均时间1.2月;5例部分改善,3个月仍氮质血症期,Scr 186~442μmol/L、BUN 10.7~15.1 mmol/L;2例中途放弃。治愈率85.7%,有效率95.9%。结论腔内技术治疗梗阻性肾衰具有微创、安全、疗效显著,恢复快等优点,术后肾功能恢复情况与梗阻时间成正比关系。

Objective To summarize the application of upper urinary tract obstructive renal failure in different cause by minimally invasive endoscopic technology.Methods 49 of renal failure cases were recruited,and 34 cases were suffering with upper urinary stone and 15 cases of urinary obstruction were caused by various reasons of diseases.The patients were treated by technique such as ureteroscopy,the balloon dilatation,double J catheter placing,and mini-percutaneous nephrolithotomy.Results All the obstructions in 49 cases were removed,and normal renal function have been regained by acute obstruction in 37 cases in one to five days.The chronic obstruction in 5 cases was recovered from normal renal function for average 1.2 month,and the part patients was improved in 5 cases for three month.The serum creatinine was 186-442 μmol/L,BUN dropped 10.3～14.8 mmol/L,but halfway abandon in 2 cases.The cure rate was 85.7%,and effective rate was 95.9%.Conclusions Minimal invasive endoscopic technology is a safe,minimal invasive,effective method.The post-operation recover condition has a positive correlation with the obstructive time.