上尿路结石致重度肾积水的临床治疗(附27例报道)

Clinical treatment of severe renal hydronephrosis caused by upper urinary tract calculi in 27cases

目的探讨上尿路结石致重度肾积水的临床治疗及最大可能保肾的可行性。方法 27例上尿路结石均致患侧重度肾积水,其中输尿管中下段结石12例,肾盂出口及输尿管上端结石8例,肾脏多发结石5例,肾脏多发结石伴输尿管结石2例;27例患者中,6例伴有对侧上尿路结石,采用经尿道输尿管镜,开放性肾切除、经皮肾穿刺造瘘及经皮肾输尿管镜等治疗手段。结果3例行肾切除,其余24例均成功处理结石并保肾成功。结论对于上尿路结石致重度肾积水患者,可结合尿动力学检查,在安全膀胱情况下尽可能保肾。

Objective To discuss the clinical treatment of severe renal hydronephrosis induced by upper urinary tract calculi and to explore the feasibility of preserving the kindly at highest possibility.Methods Totally 27 cases of severe renal hydronephrosis induced by upper urinary tract calculi were enrolled including 12 cases of lower ureteral calculi,8 cases of renal pelvis and upper ureteral calculi,5 cases of multiple renal calculi,2 cases of multiple renal calculi complicated with ureteral calculi.In the 27 patients,6 patients were with contralateral upper urinary tract calculi.Transurethral ureteroscopy,open nephrectomy,percutaneous nephrostomy,percutaneous ureteroscopy and other treating methods were employed.Results Nephrectomy was performed on three patients while the calculi were dealt with and kidneys were preserved successfully in the remaining 24 patients.Conclusion Preserving the kidney should be practiced for the severe renal hydronephrosis induced by upper urinary tract calculi based on the urodynamic examination.