出血倾向对肾后性肾衰急诊处理的影响

THE INFLUENCE OF BLEEDING TENDENCY ON EMERGENT MANAGEMENT FOR PATIENTS WITH POSTRENAL RENAL FAILURE

探讨肾后性肾衰时 ,患者存在出血倾向对外科急诊处理的影响。作者对 1988年 3月～ 2 0 0 0年 12月期间收治的 86例梗阻性肾衰急诊处理方法及其并发症进行了回顾性分析。其结果显示 :开放手术 14例 ,其中 1例死亡 ,出血量大于 10 0 0ml3例 ;经皮肾穿刺造瘘 39例 ,其中死亡 2例 ,肾切除 3例 ;逆行输尿管插管引流 32例 ,输尿管镜取石 1例 ,无 1例发生严重并发症。表明存在出血倾向的肾后性肾衰病例 ,急诊开放手术或经皮肾穿刺造瘘术可能引起难以控制的肾脏大出血 ,导致死亡或丢失肾脏。

In order to investigate the influence of bleeding tendency on emergent treatment of postrenal renal failure patients, we retrospectively studied the methods and complications of emergent treatment in 86 renal failure patients induced by postrenal obstruction hospitalized from March 1988 to December 2000. Fourteen patients were treated by emergent open operation, in whom one died after operation because of severe bleeding,and 3 with total bleeding volume more than 1000ml. Thirty nine patients were treated with percutaneous nephrostomy, in whom 2 died after operation and 3 had to undergo mephrectomy.32 patients were treated with retrograde indwelling ureteral stent and one with transureteroscopic lithotomy (TUL),without the occurrence of complications. Emergent open operation and percutaneous nephrostomy for renal failure patients induced by postrenal obstruction may induce uncontrolled renal bleeding,resulting in patient death or kidney loss because of bleeding tendency.The retrograde ureteral catheterization for drainge is recommended as the first option for emergent treatment of renal failure patient induced by postrenal obstruction.