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目的评估急诊输尿管镜下气压弹道碎石术处理输尿管结石致急性梗阻性肾衰竭的疗效。方法回顾性分析2006年7月~2008年11月22例输尿管嵌顿性结石梗阻致肾后性急性肾衰竭患者资料,患者入院后24h急诊手术行输尿管镜检查及气压弹道碎石取石术(其中4例接受急诊血液透析),术毕安置双“J”管内引流。术后随访泌尿系彩超、腹部X线片(KUB)4周。结果 4例患者由于严重水钠潴留、高血钾接受急诊血液透析。所有患者输尿管镜下气压弹道均成功碎石,平均手术时间43.4(23~114)m in,碎石成功率92.5%(37/40),患者术后结石清除率86.4%(19/22)。术后20例患者(90.9%)于术后10d肾功能恢复正常,2例患者(9.1%)肾功能显著恢复,但随访12周仍未恢复至正常范围内。无术中并发症及术后输尿管狭窄等发生。结论输尿管镜下气压弹道碎石治疗输尿管结石梗阻性急性肾衰竭安全、有效,并可同期处理双侧输尿管结石。
Objective To evaluate the efficacy of emergency ureteroscopic pneumatic lithotripsy in the treatment of acute obstructive renal failure caused by ureteral calculi. Methods A retrospective analysis of 22 patients with ureteral incarcerated renal proximal renal acute renal failure from July 2006 to November 2008 was performed. The patients underwent emergency ureteroscopy and pneumatic lithotripsy 4 patients received emergency hemodialysis), surgery completed double “J ” tube drainage. Postoperative urinary ultrasound, abdominal radiography (KUB) for 4 weeks. Results Four patients received emergency hemodialysis due to severe water-sodium retention. All patients underwent ureteroscopic pneumatic lithotripsy successfully gravel, the average operative time was 43.4 (23 ~ 114) mins, the success rate of gravel 92.5% (37/40), and the postoperative stone clearance rate was 86.4% (19/22). The postoperative renal function of 20 patients (90.9%) returned to normal 10 days after operation. Renal function recovered significantly in 2 patients (9.1%), but did not recover within the normal range after 12 weeks of follow-up. No intraoperative complications and postoperative ureteral stenosis occurred. Conclusions The ureteroscopic pneumatic lithotripsy is safe and effective in the treatment of ureteral calculi obstructive acute renal failure and can treat bilateral ureteral calculi in the same period.