留置双J管在小儿上尿路结石并急性肾功能衰竭中的应用

Application of indwelling double J catheter in children with upper urinary calculi and acute renal failure

目的 探讨留置双J管在小儿上尿路结石并急性肾功能衰竭中的应用效果.方法 16例上尿路结石并急性肾功能衰竭患儿,均有少尿或无尿病史,入院后急查肾功能、电解质,血肌酐(Cr)及尿素氮明显升高,符合急性肾功能衰竭标准,彩超检查均提示肾脏、输尿管内强回声团或絮状强回声,所有患儿入院后均给予留置双J管解除梗阻,观察治疗效果.结果 14例患儿肾功能恢复正常,2例患儿肾功能明显好转.双J管留置时间4~8周,复查彩超及CT提示12例结石排出,4周后拔除双J管;2例患儿结石<0.8 cm带管行体外震波碎石(ESWL),术后嘱患儿大量饮水、适度活动,结石均排出;2例患儿结石>1.2 cm,置管4周后行输尿管软镜下钬激光碎石取石术.结石排出后均顺利拔除双J管.结论 留置双J管对上尿路结石并急性肾功能衰竭患儿有疗效确切、安全可靠、创伤小等优点,可以有效的解除梗阻、保护肾功能,适合医院推广应用.

Objective To discuss the application effect of indwelling double J catheter in children with upper urinary calculi and acute renal failure.Methods 16 children with upper urinary calculi and acute renal failure had a history of oliguria or no urinary.After admission,renal function and electrolytes were examined urgently.Serum creatinine(Cr)and urea nitrogen were significantly elevated,which was consistent with acute renal failure criteria.All showed a strong echo mass or flocculent echo in kidney or ureter.All the children received indwelling double J tube to relieve the obstruction after admission.The therapeutic effect was observed.Results Renal function returned to normal in 14 cases and improved significantly in 2 cases.Double J-catheter indwelling time was 4-8 weeks.12 cases of calculi were discharged according to color Doppler ultrasonography and CT,and double J-catheter was removed 4 weeks later.Extracorporeal shock wave lithotripsy(ESWL)was performed in 2 children with calculi<0.8 cm.After operation,the children were instructed to drink a lot of water and exercise moderately,and the calculi were discharged.2 children with calculi>1.2 cm underwent holmium laser lithotripsy under flexible ureteroscope 4 weeks after catheterization.Double J catheter were successfully removed after the calculi was discharged.Conclusion Indwelling double J catheter has the advantages of certain efficacy,safe and reliable,and small trauma for children with acute urinary calculi and acute renal failure.It can effectively relieve obstruction and protect kidney function,and is suitable for promotion and application in hospital.