老年人上尿路结石梗阻致急性肾功能衰竭的诊断和急诊处理

Diagnosis and treatment of the acute renal failure caused by upper urinary lithiasis obstruction in the old

目的 提高老年上尿路结石梗阻致急性肾功能衰竭的诊断和急诊治疗水平。方法 回顾分析了 33例老年上尿路结石致急性肾功能衰竭的诊断和急诊治疗过程 ,总结诊断和治疗方法。结果 33例患者经KUB发现阳性结石 2 4例 ,全部经泌尿系CT检查确诊。 33例均急诊处理 ,其中 7例行经皮肾穿刺造瘘 ,2周后Ⅱ期处理结石 ;6例行一侧经皮肾穿刺造瘘术、一侧行输尿管镜碎石术 ;2 0例行输尿管镜气压弹道碎石术 ,2例两侧输尿管结石行输尿管镜碎石入镜失败 ,改行输尿管切开取石术 ;术后肾功能均得到改善 ,血清肌酐下降。结论 老年上尿路结石致急性肾功能衰竭需早期诊断和治疗 ,CT是较好的诊断方法 ,应以简单、有效、创伤少的方法解除梗阻 ,建议以输尿管镜气压弹道碎石术和经皮肾穿刺造瘘为首选方法。

Objective To improve the lever of the diagnosis and treatment of the acute renal failure resulted from obstruction of upper urinary multiple lithiasis in the old.Methods To retrospectively analyze 33 cases of acute renal failure caused by upper urinary multiple lithiasis obstruction in the old.Results In 33 cases,24 patients were found lithiasis by KUB X-ray.All patients were diagnosed through CT scan.There were 7 patients' obstruction were relieved through percutaneous nephrocentesis,and managed the calculus two weeks later;20 patients by pneumatic impactor lithotripsy under ureterscope,whereas 6 patients through percutaneous nephrocentesis in one side and by pneumatic impactor lithotripsy under ureterscope in the other side,and among them 2 patients' two side lithiasis were falure for ureterscopy and followed by ureterlithotomy.All the renal function improved to a vary of degrees.Conclusion The acute renal failure resulted from obstruction of upper urinary multiple lithiasis in the old should be diagnosed and treated earlier.CT scan was a good method for diagnosis.The obstruction should be relieved by the effective,less wound and simple way.We suggest that pneumatic impactor lithotripsy under ureterscope and percutaneous nephrocentesis are the first managements for emergency treatment.