钬激光输尿管软硬镜结合治疗结石梗阻性急性肾功能衰竭39例分析

目的探讨钬激光输尿管软硬镜治疗输尿管结石致急性梗阻性肾衰竭的应用价值。方法回顾性分析2006年7月～2010年12月39例输尿管嵌顿性结石梗阻致肾后性急性肾衰竭患者的资料,其中36例患者入院后24h急诊手术行输尿管镜检查及钬激光碎石取石术（其中5例接受急诊血液透析）,术毕安置双＂J＂管内引流,2例输尿管中段结石因输尿管迂曲、狭窄进镜失败留置输尿管导管后行二次手术成功,1例因输尿管膀胱开口异常而中转开放手术。术后随访泌尿系彩超、腹部X线片（KUB）4～6周。结果 5例患者由于严重水钠潴留、高血钾接受急诊血液透析。38例患者输尿管镜下钬激光碎石获得成功,平均手术时间45.3（20～125）min,碎石成功率97.2%（70/72）,患者术后结石清除率100%（38/38）。术后36例患者（92.3%）于术后10d肾功能恢复正常,3例患者（7.6%）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。结论钬激光输尿管软硬镜结合治疗输尿管结石梗阻性急性肾衰竭安全、有效,可同期处理双侧输尿管结石及肾结石,并且可一次性将结石完全清除。

Transureteroscopic Holmium laser in the treatment of acute renal failure induced by postrenal ureteric stone obstruction(report of 39 cases)

Objective To assess the value of transureteroscopic Holmium laser in the treatment of acute renal failure induced by postrenal ureteric stone obstruction.Methods Data of 39 patients with obstructive acute renal failure caused by impacted ureteral calculi surgically treated in our hospital during Jul.2006 to Dec.2010 were retrospectively analyzed.36 patients received emergency transureteroscopic Holmium laser lithotripsy within 24 hours and had doubl-J stent placed.2 cases received a second surgery due to ureteral kink and stricture,and calculi were successfully crushed after ureteral catheter was placed.1 patient switched to open surgery because of ureteral distortion.During the follow-up of 4~6 weeks,ultrasonography and/or plain film radiograph were performed.Results 5 patients had to receive emergency hemodialysis(HD) due to severe sodium and water overload and/or hyperkalemia.38 patients successfully underwent transureteroscopic Holmium laser lithotripsy.The mean operation time was 45.3 min,ranging 20~125 min.The success fragmentation rate was 97.2%(70/72),and the overall stone-free rate was 100%(38/38).36 patients(92.3%) restored renal function within 10 days.3 patients(7.6%) had significant improvement,but the renal function didn’t recover 12 weeks after operation.No intraoperative complications or postoperative ureteral stricture occurred.Conclusions Transureteroscopic Holmium laser lithotripsy is effective and safe in treating acute ureteral obstruction and postrenal failure caused by calculi,and the bilateral ureteral calculi and kidney calculi could be fragmented simultaneously.