独肾急性上尿路梗阻并脓毒性休克、急性肾功能衰竭微创外科治疗  

Minimally Invasive Surgery in Treatment of Single-Kidney Patients with Acute Upper Urinary Tract Obstruction Complicated by Septic Shock and Acute Renal Failure

作　　者：袁鹏飞[1] 杨英刚[1] 郭建军[1] 梁荣兴[1] 蔡恒[1] 

机构地区：[1]武警四川总队医院泌尿外科,四川乐山614000

出　　处：《临床误诊误治》2014年第8期81-84,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的观察独肾急性上尿路梗阻并脓毒性休克、急性肾功能衰竭微创外科治疗效果。方法对我院收治的采用微创外科治疗的独肾急性上尿路梗阻并脓毒性休克、急性肾功能衰竭28例的临床资料进行回顾性分析。结果本组行微创经皮肾穿刺造瘘术17例,输尿管逆行插管11例。28例均及时解除上尿路梗阻,全身情况得到明显改善,肾功能有不同程度恢复,仅3例行血液透析1次,2例予长期留置肾造瘘管引流。28例微创外科治疗后血白细胞计数、血尿素、血肌酐及尿量均较治疗前明显改善,差异均有统计学意义(P<0.01)。结论积极抗感染,纠正休克和水、电解质、酸碱平衡紊乱同时,行微创经皮肾穿刺造瘘术或输尿管插管引流术缓解独肾急性上尿路梗阻效果满意。Objective To explore the effect of minimally invasive surgery in treatment of single-kidney patients with acute upper urinary tract obstruction complicated by septic shock and acute renal failure. Methods 28 single-kidney patients with acute upper urinary tract obstruction complicated by septic shock and acute renal failure underwent minimally invasive treatment in our hospital, and the clinical data was retrospectively analyzed. Results Among these patients, 17 cases were operated with minimally invasive percutaneous nephrostomy drainage, 11 cases were treated by placing ureteral stent retro-gradely under ureteroscopy. All cases removed the upper tract obstruction in time, body states also were effectively improved, and patients＇ renal function recovered to different extent. There were 3 cases needing hemodialysis 1 time, and 2 cases treated with long-term indwelling renal fistula drainage. White blood cell count, blood urea nitrogen, serum creatinine and urine vol-ume in all patients were significantly improved post-operation when compared with those pre-operation （P〈0. 01）. Conclu-sion It is crucial to operate minimally invasive percutaneous nephrostomy and retrograde ureteral catherer placing besides an-tibiotic therapy, correction of shock and electrolytic equilibrium for single-kidney patients with acute upper urinary obstruction complicated by septic shock and acute renal failure.

关 键 词：独肾 尿道梗阻 休克 脓毒性 肾功能不全 外科手术 微创性 

分 类 号：R699[医药卫生—泌尿科学]