输尿管梗阻致急性肾衰竭45例的治疗 (pdf)

    [摘要] 目的 探讨输尿管梗阻致急性肾衰竭时的急诊处理方法，以保护和恢复肾功能。方法 输尿管梗阻致急性肾衰病人45例，均以少尿或无尿1～6天来诊。经生化检查均存在肾功能不全，经B超，CT，X线摄片及(或)急诊经膀胱输尿管插管均诊断为输尿管梗阻。分别急诊行输尿管插管、输尿管镜或输尿管切开取石、肾造瘘、血液透析。并在1～12天内根据病情进行了后期病因治疗。结果 7例保留永久肾造瘘或输尿管皮肤造口，2例进入永久血液透析。其余36例均解除梗阻恢复生理排尿通道，梗阻症状均消失。共有38例患者出现多尿期，持续1～2周。血BUN，Cr随访，3天～5个月内可恢复，恢复程度80%～100%。结论 经膀胱镜输尿管插管是输尿管梗阻致急性肾衰时首选处理；肾造瘘术则是插管失败的急诊补救措施及病因不能解除时永久引流尿液的措施；双“J”管的应用代替了部分肾造瘘。

    [关键词] 输尿管梗阻；肾造瘘

    Treatment of acute renal failure resulted from upper urinary tracts obstruction

    YI Dong-xu.Liaoning Institute for Family Planning,Shenyang 110031,China

    [Abstract] Objective To detect the urgent management to protect and save the renal function for the cases who have acute renal failure resulted from ureteral obstruction.Methods 45 cases of acute renal failure resulted from upper urinary tracts were survryed in this report.Emergency was defined as ureteral obstruction, acute renal failure, by the result of lab and ultrasound. Ureteral ureteral stenting catheter insertion was attempt at all of the cases.Nephrostomy,dialysis and urgent operation were used at cases who had failed to insert catheter.Results 7 patients remain permanent nephrostomy.2 patients combined with continually dialysis.36 patients were all cured,and the renal function recovered 80%～100% in 3 days～5 months.Conclusion The first urgent management for acute renal failure resulted from ureteral obstruction is ureteral catheter insertion,nephrostomy is counterplan.Double-J stenting replaced some nephrostomy. ......