梗阻性无功能肾切除指征的探讨  

Nephrectomy indications of postrenal obstructive non-functioning kidney

作　　者：邵雄杰[1] 湛海伦[1] 周祥福[1] 司徒杰[1] 王德娟[1] 温星桥[1] 肖恒军[1] 高新[1] 

机构地区：[1]中山大学附属第三医院外科,广州510630

出　　处：《中国临床实用医学》2009年第9期72-74,共3页China Clinical Practical Medicine

摘　　要：目的探讨梗阻性无功能肾行肾切除的指征。方法回顾性分析近4年本科48例因。肾后性梗阻导致重度肾积水的诊治情况，所有患者术前患肾肾小球滤过率（GFR）〈10ml／min。根据治疗过程是否肾切除分为两组：肾切除组（25例），保留肾脏组（23例）。所有患者术前均行检查血清肌酐（SCr）、泌尿系B超、静脉肾盂造影（IVP）、多层螺旋CT尿路造影（双肾CT＋CTU）、核素肾动态显像（ECT）及肾静态显像。术后3个月所有患者均复查SCr，保留肾脏组还复查B超、IVP及ECT。保肾组16例患者术前行肾造瘘术，观测患肾尿液引流情况，手术解除梗阻因素后保留肾脏，观察患肾恢复情况。结果肾切除组术后SCr轻微升高，无统计学差异。保留肾脏组21例患者SCr明显改善，B超及IVP提示肾积水明显减轻，肾动态GFR较术前明显提高，仅有2例术后肾积水无明显改善发展至脓肾，再次手术切除患肾。结论临床上梗阻性无功能肾行肾切除的指征具有一定复杂性，需根据肾动态GFR、患肾皮质厚度、尿量、尿pH值、尿比重、尿渗透压、肾动脉血流阻力指数、是否合并感染、患者年龄及对侧肾代偿情况进行综合考虑。Objective To discuss the nephrectomy indications of postrenal obstructive non-functioning kidney. Methods 48 cases of postrenal obstructive non-functioning kidney were analyzed retrospectively. All the case glomerular filtration rate（ GFR）of non-functioning kidney were less than 10 ml/min. According to the treatment,the cases were divided into two groups ：the first group included 25 cases whose renal was cut off,and the second group included 23 cases with reservation renal. The serum creatinine, ultrasound, IVP, CT ＋ CTU and ECT were performed for each case before operation, and the serum creatinine were also checked with each case after the operation 3 months later. The second group were also performed ultrasound, IVP and ECT. Sixteen cases in second group were done nephrostomy before surgical treatment, and the drainage were observed. Then the surgery were done for removing the obstruction. Results The serum creatinine rise little in first group, and there was no significant differences. The serum creatinine, ultrasound, IVP, and GFR were significantly improved in 21 cases of the reservation renal group. Only 2 cases the hydronephrosis did not improved and develop into pyonephrosis, and had to cut off the kidney eventually. Conclusion The nephrectomy indications of postrenal obstructive non-functioning kidney were complicated. We should take into consideration of the GFR, the thickness of renal cortex, urine volume, urine pH value, urine specific gravity, urine osmotic pressure, renal artery resistive index, infection of urine, the patient age and the opposite side renal compensation.

关 键 词：无功能肾 肾切除 肾后性梗阻 

分 类 号：R699[医药卫生—泌尿科学]