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目的 探讨微创外科技术在急诊处理梗阻性急性肾功能衰竭 (肾衰 )的手术治疗方法和临床价值。方法 运用输尿管镜检、气压弹道碎石、微创经皮肾镜取石、输尿管狭窄内切开、留置双J管等微创外科技术急诊治疗梗阻性急性肾功能衰竭。术后随访 1～ 12个月 ,追踪测定BUN、SCr。结果 4 3例病人均成功地解除输尿管梗阻并留置双J管 ,其中 37例经尿道逆行上镜手术 ,6例改行微创经皮肾穿刺顺行入镜手术 ,无腔内手术失败改开放手术的病例。手术时间 15～ 180min ,平均 75min。 4 2例疗效满意 ,1例死亡。结论 微创外科技术急诊处理梗阻性急性肾功能衰竭 ,具有创伤小、疗效确切、安全可靠 ,能同时处理双侧输尿管梗阻病变 ,病人术后恢复快的优点 ,可作为首选治疗方法。同时要重视对多器官功能障碍综合征的预防。
Objective To investigate the surgical treatment and clinical value of minimally invasive surgery in emergency treatment of obstructive acute renal failure (renal failure). Methods Ureteroscopy, pneumatic lithotripsy, minimally invasive percutaneous nephrolithotomy, ureteral stricture incision, double J tube and other minimally invasive surgical emergency treatment of obstructive acute renal failure. All the patients were followed up for 1 to 12 months, followed by BUN and SCr. Results All 43 patients were successful in relieving ureteral obstruction and leaving double J tube, including 37 cases of transurethral retrograde operation and 6 cases of minimally invasive percutaneous nephrolithotomy. Case. Surgery time 15 ~ 180min, an average of 75min. Forty-two patients were treated satisfactorily and 1 patient died. Conclusion Minimally invasive surgical treatment of acute obstructive acute renal failure with trauma, exact effect, safe and reliable, can simultaneously treat bilateral ureteral obstruction lesions, the advantages of rapid recovery after surgery, can be used as the preferred method of treatment. At the same time pay attention to the prevention of multiple organ dysfunction syndrome.