张　年

沭阳县中医院泌尿外科，江苏宿迁　223600

上尿路结石所致急性梗阻性肾功能不全的微创手术治疗

张年

沭阳县中医院泌尿外科，江苏宿迁223600

目的 探讨微创手术治疗上尿路结石所致急性梗阻性肾功能不全的效果。方法 整群选取并回顾性分析2014年11月—2015年11月在该院采取微创手术治疗的76例上尿路结石导致的急性梗阻性肾功能不全患者的临床病例资料，比较患者术前术后尿量、生命体征、血象和肾功能等变化情况。结果 76例患者采取经皮肾造瘘以及输尿管逆行插管引流术治疗后尿路梗阻均成功解除，邻近器官未见大出血和大损伤以及败血症等并发症出现，术后患者生命体征平稳，尿路梗阻解除后患者血尿氮、血清肌酐等肾功能指标均明显改善，尿量较前显著增多，术前术后比较差异具有统计学意义 （P＜0.05）。结论 早期解除尿路梗阻以及联合使用抗菌药物是治疗上尿路结石导致的肾功能不全并发肾感染积脓患者的处理原则，采用经皮肾造瘘术和输尿管插管引流术等微创手术治疗有助于改善患者肾功能和生命体征。

上尿路结石；急性梗阻；肾功能不全；微创手术疗法

［Abstract］Objective Discussion on minimally invasive surgical treatment of urinary tract calculi induced acute obstructive renal insufficiency results.Methods Group selection retrospective analysis November 2014— November 2015 to take on minimally invasive surgical treatment of 76 cases of urinary tract stones obstruction caused by acute renal insufficiency in patients with clinical data，compared before and after surgery in patients with urine in our hospital，vital signs，blood and kidney function changes.Results 76 patients taking percutaneous nephrostomy and retrograde ureteral catheterization drainage treatment of urinary tract obstruction were successfully released，adjacent organs and no large damage and bleeding complications such as sepsis，patients with stable vital signs，urinary tract obstruction after the lifting of patients blood urea nitrogen，serum creatinine，and other renal function parameters were significantly improved，significantly increased urine output than before，after the preoperative difference was statistically significant（P＜0.05）.Conclusion Early relieve urinary tract obstruction and joint use of antibiotics is the treatment of urinary tract stones cause kidney dysfunction in patients with renal infection empyema principles，percutaneous nephrostomy and ureteral catheterization drainage and other minimally invasive surgical treatment help improve renal function and vital signs.

［Key words］Upper urinary tract；Acute obstruction；Renal insufficiency；Minimally invasive surgical therapy

泌尿道系统结石以及感染是中国最为常见的泌尿性疾病，上尿路发生结石较易引起梗阻性的肾积水，并导致化脓性败血症和感染，由于尿路结石引起急性梗阻性肾功能不全发病较为急骤，病情变化较快，一旦处理不及时或不当将导致并发症，严重者将导致患者死亡［1-2］。……