婴幼儿上尿路结石致急性肾功能衰竭的急诊腔内处理  

Emergent endoscopic management of acute renal failure caused by upper urinary tract stones in infants

作　　者：加素尔·巴吐尔 威力江·赛买提[2] 阿布力米提·木合塔尔[1] 赖彩永[3] 艾克拜尔江·艾尼瓦 徐海[1] 孜比布拉·买买提 艾尔肯·吐尔逊[1] Jesur Batuer;Weilijiang Saimaiti;Abulimiti Muhetaer;Lai Caiyong;Aikebaierjiang Ainiwaer;Xu Hai;Zibibula Maimaiti;Aierken Tuerxun(Department of Urology,First People＇s Hospital of Kashgar Area,Kashgar 844000,Chin;Department of Pediatric Surgery,First Affiliated Hospital,XinJiang Medical University,Urumqi 830054,Chin;Department of Urology,First Affiliated Hospital,Jinan University,Guangzhou 510632,China)

机构地区：[1]新疆喀什地区第一人民医院泌尿外科,844000 [2]乌鲁木齐新疆医科大学第一附属医院小儿外科,830054 [3]暨南大学附属第一医院泌尿外科,广州510630

出　　处：《中华小儿外科杂志》2018年第7期497-501,共5页Chinese Journal of Pediatric Surgery

基　　金：广东省省级科技计划项目（2014A020209085）

摘　　要：目的探讨婴幼儿急性肾功能衰竭的急诊腔内处理方法。方法回顾性分析2012年1月至2016年1月177例婴幼儿上尿路结石致急性肾功能衰竭患儿的临床资料、急诊处理方法及其疗效。结果所有均尝试给予双侧输尿管DJ管置入术，其中双侧DJ管插入137例，单侧DJ管插入33例（死亡1例），引流未成功急诊行肾盂切开取石术＋DJ管置入术6例，1例保守治疗死亡。共死亡2例，余175例患儿肾功能均恢复，生存率98.87%（175/177），病死率1.13%（2/177），急诊处理后自行排石率23.73%（42/177）。术后174例（1例失访）留置DJ管时间（25.88±7.98）d，范围15～45 d；术后多尿期持续时间24～144 h，尿量（1 508±517.96）ml/24 h，范围550～3 200 ml/24 h。术后肾功能（血BUN及Cr）恢复正常时间为（2.56±0.79）d，范围1～5 d。结论上尿路结石是维吾尔族婴幼儿肾后型急性肾功能衰竭的最主要原因，采取急诊输尿管DJ管置入解除梗阻是安全有效的治疗方式。熟练的内镜操作技术可减少围手术期并发症的发生。ObjectiveTo evaluate the efficacy of emergent endoscopic management of acute renal failure （ARF） caused by upper urinary tract stones in infants.MethodsRetrospective analyses were conducted for the clinical data, emergent measures and efficacy of 177 infants with calculi obstructed ARF from 2012 to 2016.ResultsDJ stenting was successfully performed in 137 cases bilaterally and 33 cases unilaterally.Six cases underwent pyelolithotomy due to failed DJ stenting.There were two deaths.Renal functions recovered in 175 cases.Survival and mortality rates were 98.87% （175/177） and 1.13% （2/177） respectively.And 23.73% （42/177）remained stone-free after emergency measures.The average postoperative DJ-stenting time was （25.88±7.98） （15-54） days; average polyuria stage lasted 24-144 h, average urine volume （1 508±517.96） （550-3 200） ml/24 h and average time for normalized renal function （blood BUN ＆ Cr） （2.56±0.79）（1-5） days.ConclusionsUpper urinary tract calculi is a major cause of obstructed ARF in Uyghur infants.And DJ stenting is vital for reducing the occurrence of complications.

关 键 词：尿路结石 肾功能衰竭 内镜置管术 

分 类 号：R726.9[医药卫生—儿科]