输尿管镜钬激光配合输尿管管路封堵器治疗双侧输尿管结石并急性肾功能不全29例临床分析

Clinical analysis of ureteroscope using holmium:YAG laser combined with ureteral occlusion device in the treatment of bilateral ureteral calculi with acute renal insufficiency in 29cases

目的：研究输尿管镜钬激光配合输尿管管路封堵器治疗双侧输尿管结石并急性梗阻性肾功能不全的疗效和安全性。方法：回顾29例双侧输尿管结石并急性梗阻性肾功能不全患者资料,均采用输尿管管路封堵器固定结石输尿管镜钬激光碎石解除梗阻,术中留置双J管,并比较手术前、手术后血肌酐（SCr）、血尿素氮（BUN）、24小时尿量的变化情况。结果：29例一次性手术成功,手术时间35～70min;SCr、BUN于术后2天开始下降,25例术后1周SCr、BUN正常,4例SCr维持在286～437μmol/L,BUN 13.0～19.3mmol/L,术后4周影像学随访,29例无明显结石残留。术后随访3～9个月,结石无复发,28例肾功能正常,1例SCr维持在268～275μmol/L之间,BUN 13.0～14.1mmol/L之间。结论：输尿管镜钬激光配合输尿管管路封堵器治疗双侧输尿管结石并急性梗阻性肾功能不全安全、迅速、疗效显著,患者恢复速度快,可作为此类疾病重要的治疗方法之一。

Objective：To evaluate the clinical efficacy and safety of ureteroscope using holmium：YAG laser combined with ureteral occlusion device in the treatment of bilateral ureteral calculi with acute renal insufficiency.Method：We retrospectively reviewed the data of 29cases of bilateral ureteral calculi with acute obstructive renal insufficiency.All patients were treated with the ureteral occlusion device to fix stones and then holmium：YAG laser lithotripsy was taken to relieve the obstruction.Double-J stents were placed during surgery.We compared the change of blood creatinine（SCr）,blood urea nitrogen（BUN）and 24-hour urine before and after surgical operation.Result：All surgeries were successfully completed at the first time.The time of operation was 35-70min.All patients＇ SCr and BUN began to decline two days after the operation.Twenty-five patients＇ SCr and BUN became normal one week postoperatively,and the results of four patients＇ SCr and BUN were 286-437μmol/L and 13.0-19.3mmol/L respectively.No residual stone was found by imaging examination four weeks after the operation.After three to nine months＇ follow-up period,no patient relapsed,28patients＇ renal function returned to normal,and one patient＇s SCr and BUN were 268-275μmol/L and 13.0-14.1mmol/L respectively.Conclusion：Ureteroscope using holmium：YAG laser combined with ureteral occlusion device in the treatment of bilateral ureteral calculi with acute renal insufficiency can be used as one of the most important therapies because of its safety,effectiveness,easy-to-operate and quick recovery.