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目的:探讨无痛性上尿路结石并肾功能衰竭的微创治疗方法。方法:采用输尿管镜下气压弹道碎石取石,输尿管镜下置双J管、术后ESWL,经皮肾镜碎石术及一期行经皮肾穿刺造瘘、二期行输尿管镜碎石、ESWL或经瘘道碎石取石等微创方法治疗36例无痛性上尿路结石并肾功能衰竭。结果:术后2周～3个月肾功能恢复正常者26例;术后3个月10例仍有不同程度的氮质血症,但肾功能明显改善,从术前平均血肌酐(Cr)825.4μmol/L(412～2421.5)降低至术后平均血肌酐276.6μmol/L(175～468)。从术前平均尿素氮(BUN)25.6 mmol/L(12.6～48.3)降低至术后平均尿素氮10.76 mmol/L(9.26～12.2)。结石残留4例(结石清除率率为88.9%),无一例死亡。结论:微创治疗无痛性上尿路结石并肾功能衰竭方面具有创伤小,病人易耐受,安全性好的优点,根据病人的具体情况选择不同的微创治疗方案。
Objective: To explore the minimally invasive treatment of painless upper urinary tract stones and renal failure. Methods: Ureteroscopic lithotripsy with lithotripsy, double J tube under ureteroscopy, postoperative ESWL, percutaneous nephrolithotripsy and percutaneous nephrolithotomy were performed in one stage. Ureteroscopic lithotripsy, ESWL Or fistula lithotripsy and other minimally invasive treatment of 36 cases of painless upper urinary tract stones and renal failure. Results: There were 26 cases of normal renal function recovered from 2 weeks to 3 months after surgery. There were still 10 cases of azotemia at 3 months after operation, but the renal function was improved obviously. From preoperative mean serum creatinine (Cr) 825.4μmol / L (412 ~ 2421.5) to mean postoperative serum creatinine 276.6μmol / L (175 ~ 468). The average preoperative urea nitrogen (BUN) 25.6 mmol / L (12.6 ~ 48.3) decreased to mean postoperative urea nitrogen 10.76 mmol / L (9.26 ~ 12.2). 4 cases of residual stones (stone clearance rate was 88.9%), no one died. Conclusion: Minimally invasive treatment of painless upper urinary tract stones and renal failure with less trauma, patient tolerance, good safety, according to the specific circumstances of patients choose different minimally invasive treatment options.