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目的:总结上尿路结石所致急性梗阻性肾功能不全并感染的治疗临床经验。方法:选取2012年1月至2016年12月高州市中医院收治的36例上尿路结石梗阻性肾功能不全并感染患者为研究对象,分析其治疗效果。其中输尿管中下段结石者14例,予行输尿管镜气压弹道碎石或钬激光碎石、取石术(USR),留置双J管内引流术12例,输尿管镜下逆行插管引流2例,3周后行体外冲出波碎石。输尿管上段结石及肾结石22例,经皮肾穿刺造瘘(MPCN)18例,引流1周后行二期经皮肾镜碎石;经皮肾镜碎石取石术(MPCNL)4例,所有患者术前、术中及术后均使用第三代头孢类抗生素。7例因血尿素氮(BUN)、血肌酐(Cr)较高及电解质紊乱术前予行血液透析1~2次。结果:所有患者均成功解除了尿路梗阻,尿路感染及肾功能不全得到治愈或好转,无邻近脏器损伤或大出血、败血症等严重并发症。结论:治疗上尿路结石引起肾功能不全合并感染的处理原则是早期解除梗阻,而解除梗阻的方法要根据病人的具体情况选择采用不同的微创治疗方法。
Objective: To summarize the clinical experience of treatment of acute obstructive renal insufficiency and infection caused by upper urinary tract stones. Methods: From January 2012 to December 2016, 36 cases of upper urinary tract obstruction renal insufficiency and infection admitted to Gaozhou Hospital of Traditional Chinese Medicine were selected as the research object, and the therapeutic effect was analyzed. The middle and lower ureteral calculi in 14 cases, ureteroscopic pneumatic lithotripsy or holmium laser lithotripsy, lithotomy (USR), indwelling double J tube drainage in 12 cases, ureteroscopic retrograde intubation in 2 cases, 3 weeks after the in vitro Rush out the wave of rubble. Twenty-two cases of upper ureteral calculi and kidney stones, 18 cases of percutaneous nephrostomy (MPCN), one stage of percutaneous nephrolithotomy after percutaneous drainage and 4 cases of percutaneous nephrolithotomy (MPCNL) The third generation cephalosporins were used before, during and after surgery. Seven patients were subjected to hemodialysis one to two times before surgery due to high blood urea nitrogen (BUN), high serum creatinine (Cr) and electrolyte imbalance. Results: All patients were successfully relieved of urinary tract obstruction, urinary tract infection and renal insufficiency were cured or improved, no adjacent organ damage or bleeding, sepsis and other serious complications. Conclusion: The treatment of upper urinary tract stones caused by renal insufficiency combined with infection is the principle of early release of obstruction, and the method of lifting the obstruction according to the specific circumstances of patients choose to use a different minimally invasive treatment.