急性上尿路梗阻性无尿的治疗方法探讨(附58例报告)

目的：探讨急性上尿路梗阻性无尿的应急治疗、病因治疗的方法及效果。方法：对58例确诊为急性上尿路梗阻性无尿患者的应急治疗、病因治疗的方法以及治疗后肾功能恢复情况进行回顾性分析，应急治疗主要为输尿管插管、经皮肾穿刺引流（PCN）、开放性肾造瘘、输尿管腹壁造口和血液透析；病因治疗根据不同病因采取不同方法。结果：应急治疗：39例急诊解除梗阻患者3个月后，24例（61．5％）肾功能恢复正常，12例（30．8％）肾功能明显改善，3例（7．7％）肾功能无改善。病因治疗：27例上尿路结石和4例输尿管狭窄患者成功去除结石和狭窄；14例肿瘤转移侵犯或压迫输尿管和3例腹膜后纤维化患者无法去除病因；3例药物结晶和结核患者均行保守治疗而愈。3例放弃治疗。3个月后，34例（61．8％）肾功能恢复正常，12例（21．8％）肾功能明显改善；9例（16．4％）肾功能无改善。结论：急性上尿路梗阻性无尿的应急治疗顺序依次为输尿管插管、肾造瘘（经皮或开放）及输尿管腹壁造口，尽早解除梗阻可获得较好疗效。上尿路结石、输尿管狭窄、药物结晶、结核等病因可得到解除，腹膜后纤维化、恶性肿瘤等无法去除病因，可行尿流改道。

Treatment of acute anuria caused by upper urinary tract obstruction (Report of 58 cases)

Objective:To study the emergent and etiological treatment of acute anuria caused by upper urinary tract obstruction.Methods:A total of 58 patients with acute anuria caused by upper urinary tract obstruction were included in this group and the emergent treatment, etiological treatment and the evaluation for recovery of renal function were analyzed. Emergent treatment were ureteral catheterization, PCN, nephrostomy, ureterostomy and hematodialysis ccording to different causes for etiological treatment.Results:Emergent treatment: upper urinary tract obstruction were removed in 39 cases, of which reanal function recoved to normal in 24 cases(61.5%), improved remarkably in 12 cases (30.8%), and became worse in 3 cases(7.7%) after follow-up for three monthes. Etiological treatment: the calculi of 27 cases and the ureteral stricture in 4 cases were removed by operation. There were 14 cases with malignant tumor and 3 cases with retroperitoneal fibrosis that not suitable to be removed on emergency. The patients with medical crystal and tuberculosis of kidney were cured with conservative treatment. In this grop, there were 55 cases obtained effective therapies, of which renal function recovered completely in 34 cases (61.8%), improved remarkably in 12 cases (21.8%), and 9 cases (16.4%) became worse by three monthes follow-up.Conclusions:The subsequences of emergent management for obstructive anuria were ureteral catheterization, nephrostomy and ureterostomy. Different management should be taken according to different etiological factors.