上尿路结石所致急性梗阻性肾功能不全的微创手术治疗

目的 探讨微创手术治疗上尿路结石致急性梗阻性肾功能不全、肾积脓感染的临床效果.方法 回顾性分析2009年5月至2012年9月收治的30例上尿路结石所致的急性上尿路梗阻性肾功能不全患者.30例均合并肾积脓感染,其中予以急诊行输尿管镜下逆行插管引流21例,经皮肾穿刺造瘘9例,配合全身应用三代头孢抗生素治疗.术前及术后记录生命体征及尿量变化,检查血像及肾功能等指标.结果 全部输尿管逆行插管引流术和经皮肾造瘘术均顺利完成,所有患者均成功解除了尿路梗阻,无邻近脏器损伤或大出血、败血症等严重并发症.术后生命体征改善,急诊解除梗阻后血尿素氮(BUN)由(23.2±3.8) mmol/L降至(5.6 ±2.2) mmol/L、血清肌酐(Scr)由(472.3± 142.5) μmol/L降至(54.8±22.3)μmol/L,尿量明显增加,肾功能改善,手术前后比较差异有统计学意义(P＜0.01).结论 上尿路结石引起肾功能不全合并肾感染积脓的处理原则是早期解除梗阻,联合全身抗感染治疗.输尿管插管引流术与经皮肾造瘘术均是有效的微创治疗方法.

Minimally Invasive Management in Patients of Acute Obstructive Renal Dysfunction Caused by Upper Urinary Calculi

Abstract： Objective Urinary stones and infection are common diseases in tropical regions. The aim of this study was to evaluate the clinical effect of minimally invasive techniques in treating patients of acute obstructive renal dysfunction accompanied with kidney empyema caused by upper urinary calculi. Methods Clinical data of 30 cases of patients, having acute obstructive renal dysfunction caused by upper urinary tract stones from May 2009 to Sep. 2012,were reviewed retrospectively.Among these patients,21 cases were treated by placing ureteral stent retrogradely under ureteroscopy, 9 cases were treated by percutaneous nephrostomy.Intravenous injection of the third-generation cephalosporin antibiotics were given to all of the patients. The patients＇ vital signs, urine volume, white blood cell （WBC） counting and the renal function were recorded before and after the operations. Results All the retrograde ureteral catheter and percutaneous nephrostomy were performed successfully. The urinary tract obstruction were all released completely, without serious complication, such as damage of adjacent organs, hematorrhea or ichorrhemia. Compared with the pre-operation, the vital signs significantly improved, the serum BUN level decreased from （23.2＋3.8）mmol/L to （5.6±2.2）mmol/L, the serum Cr level decreased from （472.3±142.5）μmol/L to （54.8±22.3）μmol/L after the nephrostomy, urine volume significantly increased and the renal function recovered. Conclusions The principle of treating obstructive renal dysfunction accompanied with kidney empyema caused by upper urinary tract stone is to release the obstruction at the early stage.Retrogradely ureteral catheter placing and percutaneaus nephrostomy are effective minimally invasive approaches.