35例急性上尿路梗阻性无尿患者的急诊处理及临床分析

目的:探讨急性上尿路梗阻性无尿患者的急诊处理方法,分析其病因及预后。方法:对我院2008年10月～2010年3月急诊收治的35名急性上尿路梗阻性无尿患者进行分析与总结,了解造成急性无尿的常见原因及其预后。结果:本组35例患者中,上尿路结石梗阻28例,腹盆部包块压迫4例,结核致输尿管狭窄2例,盆腔手术误扎输尿管1例。急诊治疗行膀胱镜下输尿管逆行插管13例,肾穿刺造瘘10例,输尿管镜取石+双J管植入6例,血液透析治疗5例,开放手术治疗1例。35例患者中,30例患者短期内肾功能恢复正常,5例患者2周后仍有氮质血症。结论:结石是导致急性上尿路梗阻性无尿最主要的原因,膀胱镜下输尿管插管术应作为首选急诊处理方法,早期诊断、及时解除梗阻是肾功能恢复的关键。

The Emergency Treatment and Clinical Analysis of Acute Upper Urinary Tract Obstruction (Report of 35 Cases)

Objective： To investigate the treatment of anuria caused by acute upper urinary tract obstruction. Methods：We performed a retrospective study on 35 patients with acute anuria caused by upper urinary tract obstruction, analyzed the etiological factors and emergency treatments. Results： The etiological factors of the obstruction were upper urinary tract calculi （28/35）, tumor （4/35）, tuberculosis （2/35） and iatrogenic damage （1/35）. The emergency treatments were intra-ureteral eannuta （13/35）, percutaneous nephrostomy （10/35）, ureteroscop- ic lithotripsy （6/35）, hemodialysis （5/35）, and open surgery （1/35）. After emergency treatment, 30 patients recovered normal renal function soon, 5 patients had azotemia after two weeks. Conclusions. Calculus is the most common reason for upper urinary tract obstruction. Intra-urcteral cannula can be used firstly to treat the obstruction. To diagnose and relieve urinary tract obstruction early is essential in the recovery of renal function.