上尿路结石致孤立肾急性肾功能衰竭的治疗

Treatment of acute renal failure of solitary kidney induced by upper urinary calculi

目的 探讨上尿路结石致孤立肾急性肾功能衰竭的急诊处理方法。 方法 上尿路结石致孤立肾急性肾功能衰竭患者 78例 ,病程 1～ 8d ,其中 72h以内者 6 8例。急诊行B超引导下经皮肾穿刺造瘘 10例 ,开放手术 2 5例 ,输尿管逆行插管成功引流 12例 ,输尿管镜下气压弹道碎石 31例。 结果 6 5例于 72h内急诊处理者 3～ 12d内血Cr由 2 0 2～ 885 μmol/L降至 5 8～ 130 μmol/L ,血BUN由 9.8～ 4 2 .4mmol/L降至 2 .8～ 7.0mmol/L ;尿量增加 ,肾功能恢复 ,临床症状消失。 13例血Cr 14 5～5 5 0 μmol/L ,1例死于继发出血及感染。 结论 上尿路结石梗阻致孤立肾急性肾功能衰竭的处理原则是早期诊断 ,尽早解除梗阻 ,有效防治并发症 ,最大限度保护肾功能。KUB和B超检查是首选诊断方法 ,输尿管镜下气压弹道碎石是首选治疗方法。

Objective To summarize and analyze the emergency management for acute renal failure of solitary kidney induced by upper urinary calculi. Methods A total of 78 cases of acute renal failure of solitary kidney induced by upper urinary calculi were included.The mean course was 2.8 days (range,1 to 8 days).The time from onset to emergency management was within 72 hours in 68 out of the 78 cases.10 cases were treated with percutaneous nephrostomy drainage (PCN) under the guidance of B-ultrasound;25 cases with emergent open surgery;12 cases with indwelling ureteral stent retrogradely;and 31 cases were treated with transurethral ureteroscopy ballast lithotrity. Results One died of bleeding and infection after operation.In 65 cases treated with in 72 hours after obstruction, the serum Cr level decreased from 202～885 μmol/L to 58～130 μmol/L;the serum BUN level decreased from 9.8～42.4 mmol/L to 2.8～7.0 mmol/L after urgent treatment during a period of 3 to 12 days,and the renal functions recovered. Conclusions The principles of management for this acute condition should be diagnosing early and promptly,releasing obstruction as soon as possible,preventing complications effectively and reserving renal functions.KUB and B-ultrasonography are the first choice of diagnostic measures.Transurethral ureteroscopy ballast lithotrity can be recommended as the first choice of emergent treatment.