急性肾后性肾功能不全的原因及综合处理（附6例报告）

目的：探讨急性肾后性肾功能不全的原因及临床处理。方法：回顾性分析2003～2008年6例肾后性肾功能不全患者的临床资料，总结治疗方法。结果：上尿路梗阻原因5例，其中盆腔肿瘤3例，子宫颈癌2例，子宫内膜癌1例；孤立肾、输尿管结石1例；乙状结肠癌根治术后造成双侧输尿管下段压迫1例。下尿路梗阻原因1例，为BPH并发尿潴留。急诊行输尿管逆行双J管置入术3例，其中双侧置管1例，单侧置管2例；血液透析后行ESWL1例；B超引导下肾穿刺造瘘术1例；留置尿管肾功能恢复后行TURP术1例。6例患者梗阻解除后，3～10天肾功能有不同程度恢复。结论：导致急性肾后性肾功能不全的原因众多，以肿瘤、结石、前列腺增生进行性尿潴留为主。急诊处理原则为解除梗阻，改善肾功能。待患者肾功能恢复后，针对不同病因进行治疗。

The Etiology and Integrated Treatment of Postrenal Acute Renal Failure

Objective： To investigate the etiology and clinical treatment of postrenal acute renal failure （PARF）. Methods：6 cases of PARF were diagnosed and treated from 2003 to 2008. The clinical data were reviewed and therapeutic strategies were summarized. Results： 5 cases caused by upper urinary tract obstruction, in which 3 cases were secondary to pelvic tumor including 2 cervical cancer and 1 endometrial cancer. 1 case was caused by ureteral calculus with solitary kidney, and 1 case by oppression of bilateral lower ureteral after sigmoid colon carcinoma radical resection. 1 case was caused by lower urinary tract obstruction secondary to benign prostatic hyperplasia （BPH） with uroschesis. 3 cases performed emergency treatment of retrograde placement of double- J ureteral stent, including 1 bilateral and 2 unilateral tube. 1 cases performed extracorporeal shock wave lithotripsy （ESWL） after hemodialysis. 1 cases performed percutaneous nephrostomy with B-ultrasonography. 1 cases performed trans-urethral resection of prostate （TURP） when the renal function had resumed after indwelling catheter. The renal function of 6 cases resumed in varying degrees in 3-10 days after remove of obstruction. Conclusions：There are some reasons account for PARF, mainly including tumor, calculus, BPH and urine retention. It is important to remove the obstruction early for resume the renal function. As the renal function recover, the patients should be treated individually based on etiology.