结石梗阻并发急性肾功能衰竭的急诊处理

目的总结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lO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。

The emergency treatment of obstructive of calculi with complicating acute renal failure

Objective To present the experiences of surgery treatment for the obstructive acute renal failure induced by urinary calculi.Methods Clinical data of 76 cases of patients with obstructive acute renal failure from 1993 to 2002 was reviewed retrospectively.11 cases were treated by emergent open operation,9 cases by dwelling ureteral stent retrogradely,36 cases by ureteroscopic manipulation,5 cases by nephrostomy or ureterostomy,10 cases were treated by ureteroscopic manipulation and open operation,5 cases of extremely poor general statues by reoperation after hemodialysis one or two time.Results Postoperatively most of the patients uremic symptoms were reduced or dissolved.56 cases obtained normal renal function after one or two weeks and 15 cases with azotenmia after three months of operation.Conclusion It is noteworthy that the surgical interventions were affected severely by the bleeding tendency caused by uremia.Ureteroscopic manipulation stent retrogradely is recommended as the first choice of emergent treatment for patients with obstructive acute renal failure by urinary calculi.