无痛性上尿路结石并肾功能衰竭的微创治疗

目的:探讨无痛性上尿路结石并肾功能衰竭的微创治疗方法。方法:采用输尿管镜下气压弹道碎石取石,输尿管镜下置双J管、术后ESWL,经皮肾镜碎石术及一期行经皮肾穿刺造瘘、二期行输尿管镜碎石、ESWL或经瘘道碎石取石等微创方法治疗36例无痛性上尿路结石并肾功能衰竭。结果:术后2周～3个月肾功能恢复正常者26例;术后3个月10例仍有不同程度的氮质血症,但肾功能明显改善,从术前平均血肌酐(Cr)825.4μmol/L(412～2421.5)降低至术后平均血肌酐276.6μmol/L(175～468)。从术前平均尿素氮(BUN)25.6 mmol/L(12.6～48.3)降低至术后平均尿素氮10.76 mmol/L(9.26～12.2)。结石残留4例(结石清除率率为88.9%),无一例死亡。结论:微创治疗无痛性上尿路结石并肾功能衰竭方面具有创伤小,病人易耐受,安全性好的优点,根据病人的具体情况选择不同的微创治疗方案。

Minimally Invasive Treatment of Obstructive Kidney Disfunction Caused by painless Upper Urinary Stones

Objective To explore the way of Minimally Invasive treatment of obstructive kidney disfunction caused by painless upper urinary stones.Methods 36 cases of obstructive kidney disfunction caused by painless upper urinary stones were treated by Minimally Invasive treatment.Results Kidney function recovered normal in two weeks to three months after operation in 26 cases;there were different degree azotemia in 10 cases in three months after operation,but the kidney function of the 10 cases had been improved significantly,the mean serum creatinine decreased from 825.4 μmol/L to 276.6 μmol/L,the mean BUN decreased from 25.6 mmol/L to 10.76 mmol/L.The stone clearance rate was 88.9%,there was no cases of death.Conclusion Minimally Invasive treatment has advantage of minimal trauma,nice tolerance of patients and nice safety in treating obstructive kidney disfunction caused by painless upper urinary stones.Different way of Minimally Invasive treatment can be selected in treating obstructive kidney disfunction caused by painless upper urinary stones according to condition of patients.