一侧输尿管结石梗阻致急性肾功能衰竭的治疗经验

Management experience of acute renal failure induced by unilateral ureteral calculi obstruction

目的总结一侧输尿管结石梗阻继发急性肾功能衰竭的原因及治疗经验，提高诊治的及时性。方法回顾性分析了浙江大学附属第一医院2008年8月至2012年7月诊治的一侧输尿管结石梗阻继发急性肾功能衰竭12例患者的临床资料，探讨其发病原因、治疗措施及转归。12例患者中，男5例，女7例，平均年龄65．7岁。其中，右侧输尿管结石伴肾积水7例，左侧输尿管结石伴肾积水5例。12例血肌酐均超过310μmol/L，其中，无尿4例，无尿持续时间1～7d，少尿8例（24h尿量少于400m1），少尿持续时间2～10d，高热11例，体温最高达40℃，血白细胞计数升高10例（〉10×109／L）、降低2例（〈4×109／L）。结果12例患者，1例施行双J管置入内引流术，10例施行经皮肾穿刺造瘘外引流术，1例施行开放取石术。11例施行内、外引流术的患者，病情稳定后予以常规方法处理输尿管结石。经抗感染、抗休克、超滤及解除梗阻的综合治疗，12例患者均渡过危险期。结论一侧输尿管结石梗阻，由于梗阻侧毒素的大量吸收，可继发对侧肾功能受损、导致急性肾功能衰竭，清除毒素、解除梗阻是治疗关键。

Objective To explore the causes and treatment options of acute renal failure induced by unilateral ureteral calculi obstruction. Methods The clinical data of 12 cases of acute renal failure induced by unilateral ureteral calculi obstruction between August 2008 and July 2012 were reviewed retrospectively. There were 5 males and 7 females with an average age of 65.7 years. Their clinical data and treatment options were retrospectively analyzed and summarized. Seven cases showed right side ureteral calculus with hydronephrosis while another 5 presented left side ureteral calculus with hydronephrosis. Serum creatinine was higher than 310 μmol/L in 12 cases. Anuria appeared in 4 cases for 1 -7 days while oliguria in 8 cases for 2 - 10 days. High fever was present in 11 cases, the highest of whom was 40 ℃. White blood cell count increased in 10 cases （ 〉 10 × 109/L） and decreased in 2 cases （ 〈4 × 109/L）. Results The therapeutic options included insertion of double J stent for internal drainage （ n = 1 ） , pereutaneous nephrostomy for external drainage （n = 10） and open operation （n = 1 ）. Traditional treatments were performed to manage ureteral calculus in the above I I cases with drainage. All cases had improved renal function after comprehensive treatment of anti-infection, antishock, rinsing stones and relieving obstruction. All 12 cases were treated successfully. Conclusions Unilateral ureteral calculus may impair eontralateral renal function and cause ae.ute renal failure due to the absorption of toxin at obstructive side. The keys of management are eliminating toxin and relieving obstruetion.