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目的总结上尿路梗阻性无尿的病因,并根据目前条件提出合适的急诊处理方案。方法96例上尿路急性梗阻致肾后性肾功能衰竭.76例行膀胱镜下输尿管逆行插管(RCU),34例行开放手术(OS),4例行经皮肾穿刺引流(PCN),4例行血透,3例行输尿管镜(URSL),2便ESWL。结果①梗阻原因:结石梗阻87.5%,肿瘤侵犯占6.3%,医源性占4.2%。②处理结果:RCU、OS、PCN、URSL、和ESWL成功率分别为69.7%、97.1%、75.0%、66.7%和50.0%。91例成功解除梗阻,成功率为94.8%;3例死亡,死亡率3.1%;2例透析维持。结论上尿路急性梗阻性无尿的病因绝大多数是结石梗阻,其次为肿瘤侵犯和手术并发症。处理方法应首选逆行插管引流和URSL;结石位于上段或下段,显影清晰,梗阻时间短,可行ESWL。上述微创方法无效,全身情况允许,开放手术仍是最有效的方法;全身情况差,PCN应是取后的外科手段;若尿毒症严重,血钾升高,严重酸中毒,血透是最适当的选择。
Objective To summarize the etiology of obstructive anuria on the urinary tract and to put forward the appropriate emergency treatment plan according to the current conditions. Methods Ninety-six patients with acute upper urinary tract obstruction caused renal renal failure, 76 underwent cystoscopic ureteral retrograde intubation (RCU), 34 underwent open surgery (OS) and 4 received percutaneous renal puncture and drainage (PCN) , 4 hemodialysis patients, 3 ureteroscopy (URSL) and 2 ESWL. Results ① obstruction causes: stone obstruction 87.5%, tumor invasion accounted for 6.3%, iatrogenic accounted for 4.2%. ② The results of the treatment: The success rates of RCU, OS, PCN, URSL and ESWL were 69.7%, 97.1%, 75.0%, 66.7% and 50.0% respectively. In 91 cases, the obstruction was successfully relieved, with a success rate of 94.8%; 3 deaths and a mortality rate of 3.1%; and 2 cases of dialysis were maintained. Conclusion The most obstructive anuria of the upper urinary tract is stone obstruction, followed by tumor invasion and surgical complications. Treatment should be preferred retrograde intubation drainage and URSL; stones in the upper or lower segment, clear development, obstruction time is short, feasible ESWL. The minimally invasive method is invalid, the general situation allows, open surgery is still the most effective method; poor general condition, PCN should be taken after the surgical means; if uremia, serum potassium, severe acidosis, hemodialysis is the most Appropriate choice.