输尿管逆行置管联合枸橼酸氢钾钠治疗上尿路阴性结石所致急性肾功能衰竭的疗效观察

Effect of ureteral retrograde catheterization combined with potassium sodium potassium citrate in the treatment of acute renal failure caused by upper urinary calculus

目的探讨输尿管逆行置管联合枸橼酸氢钾钠治疗上尿路阴性结石所致急性肾功能衰竭的疗效。方法选择2014年6月至2016年2月期间我院泌尿外科收治的34例输尿管阴性结石所致急性梗阻性肾功能衰竭患者为研究对象,所有患者均接受输尿管镜下气压弹道碎石术及逆行留置双"J"管治疗,比较治疗前后肾功能的变化。将患者根据随机数字表法随机分为两组,每组17例,对照组术后常规宣教、随访,观察组中有16例肾功能正常者在对照组基础上,出院时应用枸橼酸氢钾钠治疗,术后12周时比较两组患者双"J"管管壁结石形成情况。结果 34例患者手术均获得成功,术后1 d患者血肌酐、尿素氮分别为(348.8±108.2)μmol/L、(14.6±5.9)mmol/L,均较治疗前的(789.5±341.7)μmol/L、(29.8±10.8)mmol/L明显降低,差异均有统计学意义(P<0.05);术后2周所有患者的肾功能恢复率为91.18%;术后12周复查,观察组患者的结石排净率为100.00%,双"J"管管壁结石发生率为6.25%,明显优于对照组的76.47%和35.29%,差异均有统计学意义(P<0.05)。结论输尿管逆行置管治疗上尿路阴性结石所致急性梗阻性肾功能衰竭具有确切的效果,术后进一步联合枸橼酸氢钾钠可防止结石复发,提高临床疗效。

Objective To evaluate the effect ofureteral retrograde catheterization combined with potassium so- dium potassium citrate in the treatment of acute renal failure caused by upper urinary calculus. Methods A total of 34 patients with acute obstructive renal failure induced by ureterolithiasis, who admitted to Department of Urology of our hospital and underwent ureteroscopic pneumatic lithotripsy and retrograde indwelling Double ＂J＂ tube from June 2014 to February 2016, were selected as the research objects. The changes of renal function before and after treatment were com- pared. The patients were randomly divided into two groups according to the random number table, with 17 cases in each group. The control group was routine followed up, and sixteen patients with normal renal function in the observationgroup were treated additionally with sodium potassium hydrogen citrate at discharge. Twelve weeks after operation, the stone formation of the double ＂J＂ tube wall between the two groups was compared. Results The surgery was successful in 34 patients. One day after the operation, the serum creatinine and blood urea nitrogen were （348.8±108.2）/.tmol/L and （14.6±5.9） mmol/L respectively, which were significantly lower than （789.5±341.7） μmol/L and （29.8±10.8） mmol/L be- fore treatment （P〈0.05）. Two weeks after the operation, the renal function recovery rate of all the patients was 91.18%. Twelve weeks after the treatment, the stone release rate and stone formation of the double ＂J＂ tube wall rate in the obser- vation group were respectively 100.00% and 6.25%, which was significantly better than 76.47% and 35.29% in the con- trol group （P〈0.05）. Conclusion Ureteral retrograde catheterization has the definite effect in the treatment of acute ob- structive renal failure caused by upper urinary tract-negative stones, which combined with potassium sodium potassium citrate can prevent the postoperative recurrence of stones and improve clinical efficacy.