微创治疗上尿路结石所致急性肾功能衰竭.pdf

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1、中国微创外科杂志2014年8月箍14鲞勇塑nv!垒!：!：·729·临床研究·微创治疗上尿路结石所致急性肾功能衰竭梁建奇林灼怡黄蔚山卓梅何仍富(广东省恩平市人民医院泌尿外科，恩平529400)【摘要】目的探讨微创治疗上尿路结石所致急性肾功能衰竭的临床效果。方法2012年12月～2013年8月，对3O例上尿路结石致急性梗阻性肾功能衰竭先行输尿管置管或经皮肾穿刺造瘘，根据病情行输尿管镜取石术或微通道经皮肾镜取石术。结果均成功解除尿路梗阻，输尿管镜气压弹道取石术l8例，结石取净率94．4％(17／18)；微通道经皮肾镜气压弹道取石术12例，结石取净率91．7％(11／12)，无严重并

2、发症发生。术后3—14d血cr由285～1162l~mol／L降至58—343~mol／L。术后随访1—6个月，平均3个月，肾功能恢复正常25例，5例仍有氮质血症，但肾功能明显改善。结论输尿管镜取石术或微通道经皮肾镜取石术治疗上尿路结石所致急性肾功能衰竭具有微创、安全、效果好等优点。【关键词】上尿路结石；肾功能衰竭；输尿管镜取石术；微通道经皮肾镜取石术中图分类号：R693．4；R692．5文献标识：A文章编号：1009—6604(2014)08—0729—03doi：10．3969／j．issn．1009—6604．2014．08．O18MinimallyInvasiveMan

3、agementofAcuteObstructiveRenalFailureCausedbyUpperUrinaryCalculiLiangJianqi，LinZhuoyi，HuangWeishan，eta1．DepartmentofUrology，EnpingPeople’sHospital，Enping529400，ChinaCorrespondingauthor：LiangJianqi，E—mail：superloky@126．con【Abstract】0bjectiveToinvestigatethefeasibilityandclinicaleffectofminima

4、llyinvasivemanagementacuteobstructiverenalfailurecausedbyupperurinarycalculi．MethodsFromDecember2012toAugust2013，dataof30patientswithacuteobstructiverenalfailurecausedbyupperurinarycalculiwhounderwentminimallyinvasivemanagementwerereviewedretrospectively．Allthepatientsweregivendwellingureter

5、alstentorpercutaneousnephrostomy(PCNL)inthefirstperiod，andthen，accordingtospecificconditions，receivedeitherureteroseopicholmiumlaserlithotripsy(URL)ormini—pereutaneousnephrostomy(mini—PCNL)．ResultsAllthepatientsweretreatedsuccessfully．Thestone·freerateofURLwas94．4％(17／18)in18patientswithmidd

6、leandlowerureteralcalculi，andthestone-freerateofmini—PCNLwas91．7％(11／12)in12patients．Noureteralperforationandothercomplicationswererecorded．Inthe30cases．theserumCrleveldecreasedfrom285—1162~mol／Lpreoperativelyto58—343trmol／Lat3—14dayspostoperatively．Renalfunctionsrecoveredtonormalwithin1mont

7、hafteroperationin25cases．Differentdegreesofazotemiaremainedwithin1monthafteroperationin5cases，buttheirrenalfunctionswereimprovedsignificantly．ConclusionMinimallyinvasivetechniqueisasafeandeffectivemethodforthetreatmentofupperurinarycalculicomplicat