微创治疗上尿路结石所致急性肾功能衰竭

Minimally Invasive Management of Acute Obstructive Renal Failure Caused by Upper Urinary Calculi

目的探讨微创治疗上尿路结石所致急性肾功能衰竭的临床效果。方法2012年12月～2013年8月，对30例上尿路结石致急性梗阻性肾功能衰竭先行输尿管置管或经皮肾穿刺造瘘，根据病情行输尿管镜取石术或微通道经皮肾镜取石术。结果均成功解除尿路梗阻，输尿管镜气压弹道取石术18例，结石取净率94．4％（17／18）；微通道经皮肾镜气压弹道取石术12例，结石取净率91．7％（11／12），无严重并发症发生。术后3～14d血cr由285～1162μmol／L降至58～343μmol／L。术后随访1～6个月，平均3个月，肾功能恢复正常25例，5例仍有氮质血症，但肾功能明显改善。结论输尿管镜取石术或微通道经皮肾镜取石术治疗上尿路结石所致急性肾功能衰竭具有微创、安全、效果好等优点。

Objective To investigate the feasibility and clinical effect of minimally invasive management acute obstructive renal failure caused by upper urinary calculi. Methods From December 2012 to August 2013, data of 30 patients with acute obstructive renal failure caused by upper urinary calculi who underwent minimally invasive management were reviewed retrospectively. All the patients were given dweUing ureteral stent or percutaneous nephrostomy （PCNL） in the first period, and then, according to specific conditions, received either ureteroscopic holmium laser lithotripsy （URL） or mini-percutaneous nephrostomy （mini-PCNL）. Results All the patients were treated successfully. The stone-free rate of URL was 94.4% （17/18） in 18 patients with middle and lower ureteral calculi, and the stone-free rate of mini-PCNL was 91.7% （11/12） in 12 patients. No ureteral perforation and other complications were recorded. In the 30 cases, the serum Cr level decreased from 285 - 1162 μmol/L preoperatively to 58 -343 μmol/L at 3 - 14 days postoperatively. Renal functions recovered to normal within 1 month after operation in 25 cases. Different degrees of azotemia remained within 1 month after operation in 5 cases, but their renal functions were improved significantly. Conclusion Minimally invasive technique is a safe and effective method for the treatment of upper urinary calculi complicated with acute obstructive renal failure, and should be an alternative for acute obstructive renal failure caused by upper urinary calculi.