经尿道输尿管支架置入术与经皮肾穿刺造瘘术治疗孤立肾合并肾后性急性肾功能衰竭的疗效

Efficacy and safety evaluation of ureteral stenting and ultrasound-guided percutaneous nephrostomy for postrenal acute renal failure in patients with isolated kidney

目的探讨经尿道输尿管支架置入术与经皮肾穿刺造瘘术治疗孤立肾合并肾后性急性肾功能衰竭患者的疗效及安全性。方法回顾性分析2016年9月至2021年12月在本院行手术治疗的38例孤立肾合并肾后性急性肾功能衰竭患者的临床资料。20例患者行经尿道输尿管支架置入术(输尿管支架组), 18例患者行超声引导下经皮肾穿刺造瘘(肾造瘘组)。对比两组患者的术后并发症、术后住院时间、术前、术后第一天、术后第三天的肾功能及血红蛋白变化。结果两组术前、术后第一天及第三天的血清肌酐、血清尿素氮、血红蛋白水平比较, 差异均无统计学意义(均P>0.05)。两组手术时间、住院时间比较[(15.3±5.5)min vs.(18.3±6.6)min, (3.8±1.2)d和(4.0±1.2)d], 差异均无统计学意义(均P>0.05)。输尿管支架组术后7例发生并发症, 均为Clavien Ⅰ级并发症, 3例为术后发热, 4例为轻度肉眼血尿。肾造瘘组术后7例发生并发症, 均为Clavien Ⅰ级并发症, 血尿6例(其中3例重度血尿), 肾周血肿1例, 两组患者发生并发症情况比较, 差异无统计学意义(P>0.05)。结论两种手术方式均可在短期内有效解除上尿路梗阻, 对于孤立肾患者疗效确切及安全。

Objective To evaluate the efficacy and safety of ureteral stenting and ultrasound-guided percutaneous nephrostomy in the treatment of acute postrenal renal failure in patients with solitary kidney.Methods Clinical data of 38 acute postrenal renal failure patients with solitary kidney admitted to our hospital and accepted surgical treatment from September 2016 to December 2021 were respectively analyzed.Twenty patients underwent transurethral ureteral stenting(ureteral stent group)and 18 patients underwent ultrasound-guided percutaneous nephrostomy(nephrostomy group).Changes in renal function and hemoglobin,postoperative complications and postoperative hospital stay were compared between the two groups before,on the first and third postoperative days.Results All patients accepted emergency surgical treatment,and there were no significant differences in serum creatinine,serum urea nitrogen and hemoglobin levels before,on the first and third day after surgery between the ureteral stents group and the nephrostomy group(all P>0.05).There was no significant difference in operative time and postoperative hospital stay between the two groups[(15.3±5.5)min vs.(18.3±6.6)min,(3.8±1.2)d vs.(4.0±1.2)d,all P>0.05].In the ureteral stent group,there were 7 postoperative complications,all of which were Clavien grade I complications,postoperative fever in 3 cases,mild gross hematuria in 4 cases.In the nephrostomy group,there were 7 cases of complications,6 cases of hematuria,1 cases of perirenal hematoma,and there was no significant difference of complications between two groups(P>0.05).Results Two kind of surgical methods can effectively relieve upper urinary tract obstruction in a short period of time for isolated kidney,with efficient and safe way.