CAJ | 학술논문

目的总结一侧输尿管结石梗阻继发急性肾功能衰竭的原因及治疗经验,提高诊治的及时性.方法回顾性分析了浙江大学附属第一医院2008年8月至2012年7月诊治的一侧输尿管结石梗阻继发急性肾功能衰竭12例患者的临床资料,探讨其发病原因、治疗措施及转归.12例患者中,男5例,女7例,平均年龄65.7岁.其中,右侧输尿管结石伴肾积水7例,左侧输尿管结石伴肾积水5例.12例血肌酐均超过310 μmol/L,其中,无尿4例,无尿持续时间1～7d,少尿8例(24h尿量少于400 ml),少尿持续时间2～10d,高热11例,体温最高达40℃,血白细胞计数升高10例(＞10×109/L)、降低2例(＜4×109/L).结果 12例患者,1例施行双J管置入内引流术,10例施行经皮肾穿刺造瘘外引流术,1例施行开放取石术.11例施行内、外引流术的患者,病情稳定后予以常规方法处理输尿管结石.经抗感染、抗休克、超滤及解除梗阻的综合治疗,12例患者均渡过危险期.结论一侧输尿管结石梗阻,由于梗阻侧毒素的大量吸收,可继发对侧肾功能受损、导致急性肾功能衰竭,清除毒素、解除梗阻是治疗关键.
목적 총결일측수뇨관결석경조계발급성신공능쇠갈적원인급치료경험,제고진치적급시성.방법 회고성분석료절강대학부속제일의원2008년8월지2012년7월진치적일측수뇨관결석경조계발급성신공능쇠갈12례환자적림상자료,탐토기발병원인、치료조시급전귀.12례환자중,남5례,녀7례,평균년령65.7세.기중,우측수뇨관결석반신적수7례,좌측수뇨관결석반신적수5례.12례혈기항균초과310 μmol/L,기중,무뇨4례,무뇨지속시간1～7d,소뇨8례(24h뇨량소우400 ml),소뇨지속시간2～10d,고열11례,체온최고체40℃,혈백세포계수승고10례(＞10×109/L)、강저2례(＜4×109/L).결과 12례환자,1례시행쌍J관치입내인류술,10례시행경피신천자조루외인류술,1례시행개방취석술.11례시행내、외인류술적환자,병정은정후여이상규방법처리수뇨관결석.경항감염、항휴극、초려급해제경조적종합치료,12례환자균도과위험기.결론 일측수뇨관결석경조,유우경조측독소적대량흡수,가계발대측신공능수손、도치급성신공능쇠갈,청제독소、해제경조시치료관건.
Objective To explore the causes and treatment options of acute renal failure induced by unilateral ureteral calculi obstruction.Methods The clinical data of 12 cases of acute renal failure induced by unilateral ureteral calculi obstruction between August 2008 and July 2012 were reviewed retrospectively.There were 5 males and 7 females with an average age of 65.7 years.Their clinical data and treatment options were retrospectively analyzed and summarized.Seven cases showed right side ureteral calculus with hydronephrosis while another 5 presented left side ureteral calculus with hydronephrosis.Serum creatinine was higher than 310 μmol/L in 12 cases.Anuria appeared in 4 cases for 1-7 days while oliguria in 8 cases for 2-10 days.High fever was present in 11 cases,the highest of whom was 40 ℃.White blood cell count increased in 10 cases (＞ 10 × 109/L) and decreased in 2 cases (＜4 × 109/L).Results The therapeutic options included insertion of double J stent for internal drainage (n =1),percutaneous nephrostomy for external drainage (n =10) and open operation (n =1).Traditional treatments were performed to manage ureteral calculus in the above 11 cases with drainage.All cases had improved renal function after comprehensive treatment of anti-infection,antishock,rinsing stones and relieving obstruction.All 12 cases were treated successfully.Conclusions Unilateral ureteral calculus may impair contralateral renal function and cause acute renal failure due to the absorption of toxin at obstructive side.The keys of management are eliminating toxin and relieving obstruction.