输尿管镜气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭

目的探讨输尿管镜气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭的临床疗效。方法采用输尿管硬镜，在电视监视下，经尿道插入膀胱和输尿管，气压弹道碎石探杆将结石击碎。结果21例碎石均获成功，21例术后7d肾功能复查正常。结论输尿管镜下气压弹道碎石术治疗输尿管结石并发急性肾功能衰竭安全、有效。     

输尿管镜治疗结石梗阻致急性肾功能衰竭(附10例报告)

目的探讨输尿管镜治疗结石梗阻致急性肾功能衰竭的方法和临床疗效。方法应用输尿管镜气压弹道碎石治疗结石梗阻致急性肾功能衰竭10例患者。结果10例患者均在1个月内成功解除梗阻,复查肾功能均正常,尿素氮(BUN)及肌酐(Cr)降至正常水平。结论输尿管镜是治疗结石梗阻致急性肾功能衰竭的安全、微创、有效的方法,并可同时处理双侧梗阻。     

输尿管镜气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭--附18例报告

目的探讨输尿管镜气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭的临床疗效.方法分析应用气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭18例的临床资料.结果 18例33侧结石均一次性解除梗阻,成功率100%,1周内结石排净率84.5%(28/33).5侧结石残留,均为上段结石占15.5%,其中3例体外行震波碎石术(ESWL)、1例经皮肾镜取石术(PCL)、1例溶石治愈.并发症输尿管穿孔2例,占6.7%,经保守治愈.结论气压弹道碎石术具有适应症广、损伤小、见效快、并发症少的特点;能有效清除结石,解除梗阻,挽救肾功能.     

应用输尿管镜治疗输尿管石街并发急性肾功能衰竭(附4例报告)

自 1996年 10月来 ,应用输尿管镜治疗输尿管结石 14 8例 ,其中治疗输尿管石街 18例 ,并发急性肾功能衰竭 4例 ,疗效满意 ,报告如下。1　资料与方法1·1　临床资料　本组 4例 ,男女各 2例 ,年龄 32～ 4 7岁 ,平均 36 8岁。均为一侧输尿管石街 ,左侧 3例 ,右侧 1例 ;石街位于下段 3例 ,中上段 1例 ;石街长度 2 0～ 8 5cm ,平均 5 6cm。患侧均有不同程度肾积水 ;1例伴对侧巨大、多发肾结石 ,重度肾积水。临床表现无尿1例 ,少尿 3例 ,2 4h尿量为 2 0 0～ 4 0 0ml;均伴发热 (最高体温达 39 7℃ ) ,有消化道症状 3例 ,有出血倾向 1例。实验室检…     

输尿管镜气压弹道碎石治疗输尿管结石所致急性肾衰竭

目的 探讨输尿管镜气压弹道碎石治疗输尿管结石所致急性肾衰竭的疗效、安全性和可行性.方法 回顾性分析18例输尿管结石所致急性肾衰竭急诊行输尿管镜气压弹道碎石术患者的病历资料.结果 16例行输尿管镜气压弹道碎石术成功,并放置双“J”管内引流.2例失败者行经皮肾穿刺造瘘引流术引流尿液.4例术后有肉眼血尿,3例合并尿路感染,经止血、抗炎等治疗后治愈.随访3～6个月,无输尿管狭窄等并发症发生,肾积水消失.结论 输尿管结石所致急性肾衰竭急诊行输尿管镜气压弹道碎石术是安全可行、有效的方法.     

影像学检查阴性的输尿管结石致急性肾功能衰竭的急诊处理

目的探讨影像学检查阴性的输尿管结石致急性肾功能衰竭的急诊处理方法。方法回顾分析影像学检查阴性的输尿管结石致急性肾功能衰竭的患者36例,采用输尿管镜检查确诊,并行输尿管镜直视下取石、气压弹道碎石,术后均留置双J管。结果36例患者均在入院当天解除梗阻。尿量增加,尿毒症的症状消失,BUN、Cr恢复正常。结论应用输尿管镜诊疗影像学检查阴性的输尿管结石致急性肾功能衰竭,具有迅速明确诊断、疗效可靠、安全性高、创伤小的优点,并能同时处理双侧输尿管结石,是首选的诊疗方法。     

急性输尿管插管结合体外碎石治疗梗阻性肾功能衰竭

上尿路结石梗阻引起无尿或少尿是泌尿外科急症之一，延误治疗可能危及生命。尽快解除梗阻，可使大多数患者肾功能恢复。2000—2006年我院对41例急性梗阻性肾功能衰竭患者进行输尿管逆行插管结合体外冲击波碎石术（ESWL）治疗，取得良好效果。报道如下。     

结石梗阻并发急性肾功能衰竭的急诊处理

目的总结急诊处理由结石引起的急性梗阻性肾功能衰竭处理的经验。方法对76例由结石引起的急性梗阻性肾功能衰竭患者处理方法进行分析,其中急诊开放手术11例,输尿管内引流9例,输尿管镜处理36例,单纯肾或输尿管造瘘5例,输尿管镜 开放手术结合处理10例,5例全身情况差者先进行血液透析1~2次再手术治疗。结果全部患者尿毒症症状减轻或消失,术后1~2周肾功能恢复正常56例,15例术后3个月仍有不同程度的氮质血症。结论对此类病人应及时解除梗阻,特别注意出血倾向对外科手术的严重影响。推荐输尿管镜处理作为结石梗阻性急性肾功能衰竭的急诊处理的首选方法。     

双侧输尿管结石梗阻致急性肾衰竭的输尿管镜应用体会

目的 探讨急诊应用输尿管镜治疗双侧输尿管结石梗阻致急性肾衰竭的优越性.方法 采用经输尿管镜下气压弹道碎石术治疗双侧输尿管结石梗阻致急性肾衰竭患者32例.结果 31例解除梗阻,治疗成功率96.9%,碎石成功29例(90.6%).术后患者血尿素氮、肌酐及尿量均恢复正常或接近正常.结论 应用输尿管镜急诊治疗双侧输尿管结石梗阻致急性肾衰竭具有及时解除梗阻、有效保护肾功能、损伤小、并发症少、操作简单等优点,可以作为首选方法使用.     

影像学检查阴性的输尿管结石致急性肾功能衰竭的急诊处理

目的 探讨影像学检查阴性的输尿管结石致急性肾功能衰竭的急诊处理方法。方法 回顾分析影像学检查阴性的输尿管结石致急性肾功能衰竭的患者36例，采用输尿管镜检查确诊，并行输尿管镜直视下取石、气压弹道碎石，术后均留置双J管。结果 36例患者均在入院当天解除梗阻。尿量增加，尿毒症的症状消失，BUN、Cr恢复正常。结论 应用输尿管镜诊疗影像学检查阴性的输尿管结石致急性肾功能衰竭，具有迅速明确诊断、疗效可靠、安全性高、创伤小的优点，并能同时处理双侧输尿管结石，是首选的诊疗方法。     

Acute renal failure caused by plant extract

The authors review the case of a 30 years old female patient presenting with a 48 hours-standing anuria, who permanently used products of grist of a virtuous plant, Guarana and occasionally used a parenteral non-steroid painkiller. The clinical history and laboratory results showed acute renal and hepatic failure. The histological picture of the renal biopsy specimen verified an acute tubular necrosis. After temporary dialysis treatment, her renal function recovered progressively with compensatory polyuria. The authors would like to draw the attention to the risks of the use of over-the-counter marketed paramedicinal products, per se or in combination with pharmaceutically registered products, sold in pharmacies and nutrition supplement stores.     

Urographic appearances in renal failure due to intraluminal ureteric obstruction.

With reference to a series of 13 patients, the urographic signs seen in the conditions of acute, post-acute, chronic and acute-on-chronic obstruction are described. These are seen in a relatively pure form in patients with renal failure due to ureteric calculi. Patients in renal failure with acute, post-acute or acute-on-chronic obstruction are anuric or oliguric; patients with chronic obstruction due to bilateral ureteric stones are polyuric. After removal of the stones the urine output returns to normal in cases of acute obstruction, is reduced in chronic obstruction but is increased in post-acute obstruction. A further case is described which illustrates the importance of recognizing post-acute obstruction unaccompanied by pain: the kidney may be completely obstructed and so be destroyed. The different types of obstruction are recognized by considering the nephrographic and pyelographic signs together with the presence of pain.     

顺行与逆行输尿管镜技术处理输尿管上段嵌顿性结石的疗效比较

目的 比较顺行与逆行输尿管镜技术处理输尿管上段嵌顿性结石的疗效,并对其安全性与有效性进行评价.方法 采用输尿管镜技术共治疗输尿管上段嵌顿性结石106例,其中顺行经皮肾微造瘘入路50例(顺行组),逆行经尿道入路56例(逆行组).结果 逆行组手术成功52例(92.9%),手术时间(45±5)min,住院时间(6±1)d,一期结石清除率80.4%(45/56),7例需体外冲击波碎石术(ESWL)辅助治疗,出现手术并发症3例(5.4%);顺行组手术成功50例(100.0%),手术时间(55±8)min,住院时间(8±2)d,一期结石清除率100.0%(50/50),无手术并发症发生.两组一期结石清除率和并发症发生率比较差异有统计学意义(P＜0.05).结论 顺行与逆行输尿管镜技术处理输尿管上段嵌顿性结石均有较高的手术成功率,顺行入路的安全性与有效性更好,但手术时间及住院时间稍长.     

Acute liver failure caused by Ecstasy

Ecstasy is a synthetic amphetamine widely used as a "week-end" recreational drug because it produces euphoria and eliminate the sense of fatigue. It was initially considered to be a drug with few toxic effects, but later various complications and even fatal cases have been reported. Although the 23 year old woman already tried the Ecstasy in the past, but during the month before the admission she took 8 pills. She became icteric after 6 days taking the last pill and 3 days later her prothrombin level became very low. Due to the rapid deterioration we planed liver transplantation, but since there was no acceptable donor, we could only make plasmapheresis. The autopsy proved sever liver necrosis.     

Acute kidney failure caused by rhabdomyolysis

Rhabdomyolysis developed in the muscles of the left lower extremity of a 43 year old man leading to myoglobinuria and acute renal failure. The diagnosis of rhabdomyolysis was strengthened by muscle and renal biopsy. The renal functions were restituted after peritoneal dialysis performed four times (12 hours each) within two weeks. The possible role of alcohol or Dalgol intoxication as well the disturbed circulation in the development of rhabdomyolysis is discussed. Authors point out the benefit of peritoneal dialysis in acute renal failure caused by rhabdomyolysis.     

肾和输尿管上段结石采用输尿管软镜联合钬激光碎石术治疗的临床观察

目的分析探讨肾和输尿管上段结石采用输尿管软镜联合钬激光碎石术治疗的临床疗效。方法选取我院近年来收治的80例肾和输尿管上段结石患者作为研究对象,按照患者治疗方法将其分为研究组与对照组,每组40例,研究组患者行输尿管软镜联合钬激光碎石术治疗,对照组患者经皮肾穿刺取石术治疗,比较两组患者治疗效果。结果研究组患者治疗成功率为92.5%,术后一个月结石清除率为95.0%,对照组患者治疗成功率为90.0%,术后结石清除率为97.5%,两组患者手术成功率与结石清除率比较无显著差异（P〉0.05）;研究组患者平均手术时长为（45.0±4.0）min,平均住院时长为（3.0±0.5）d,术后并发症发生率为7.5%,对照组患者平均手术时长为（81.0±6.5）min,平均住院时长为（10.5±0.6）d,术后并发症发生率为15.0%,研究组患者平均手术时长、术后平均住院时长及并发症发生率等指标明显优于对照组（P〈0.05）,组间比较差异显著,有统计学意义。结论输尿管软镜联合钬激光碎石术治疗肾和输尿管上段结石具有较高的碎石成功率与结石清除率,有效性与安全性均有保证,可推广应用。