小儿急性上尿路梗阻性肾衰的急诊处理  

Emergent treatment of acute renal failure due to acute upper urinary tract obstruction in children

作　　者：邓永继[1] 马耿[1] 葛征[1] 陆如刚[1] 

机构地区：[1]南京医科大学附属南京市儿童医院泌尿外科,210008

出　　处：《中华小儿外科杂志》2009年第1期1-3,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨近期小儿急性上尿路结石梗阻致肾衰发病率升高的病因、临床特点、诊断及治疗。方法我院近期收治40例急性上尿路梗阻致肾衰的病例，膀胱镜下行输尿管插管引流25例，腹膜透析8例，自行解除梗阻6例，肾盂造瘘1例。结果所有40例急性肾功能衰竭患儿大部分有三鹿奶粉喂养史，主要表现为无尿，首选腹部B超检查；急性肾功能衰竭时及时解除结石梗阻，纠正酸碱失衡、水电解质紊乱。40例患儿上尿路梗阻完全解除，肾功能均恢复正常；结石成分主要为尿酸盐结石，结石多能自行排出。结论三聚氰胺诱发尿酸盐结石可能是近期小儿梗阻性肾衰的主要原因。治疗手段包括膀胱镜输尿管插管、腹膜透析等。Objective To investigate the high risk factors of elevated incidence of acute renal failure（ARF） due to acute upper urinary tract obstruction in children, and analyze its clinical manifestations, diagnosis and treatment. Methods Forty cases with ARF were treated in this hospital from Jan of 2008. Among these cases, 25 cases were treated with catheterization of ureters under ureteroscope, 8 cases with peritoneal dialysis, 6 cases with conservative treatment and the other 1 with nephrostomy. Results Most of the 40 cases with acute renal failure had the history of consumption of San Lu powdered milk. The main clinical manifestation was anuria. Urinary obstruction of all cases was relieved and the renal function recovered. Uratoma was the main component in these stones which could be discharged spontaneously. Conclusions Melamine-contaminated San Lu powdered milk induced uratoma could be the high risk factor of upper urinary acute obstructive renal failure in children. The main treatments include catheterization of ureters under ureteroscope and peritoneal dialysis.

关 键 词：尿道梗阻 肾功能衰竭 急性 膀胱镜 引流术 

分 类 号：R686[医药卫生—骨科学]