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目的:分析经皮肾镜气压弹道碎石术对患者肾功能影响的原因和机制,寻求预防方法。方法:回顾分析11例经皮肾镜气压弹道碎石患者资料,包括手术前后肾脏影像学(超声,MRU,IVP)及肾功能检查(ECT)的临床资料。结果:11例严重肾功能损害的患者,患肾滤过率均低于正常20%,ECT呈低平曲张,IVP不显像,9例重度肾积水,1例无明显积水,1例肾脏萎缩,其中7例术前存在肾盂输尿管交界部狭窄,4例术前无明显狭窄;8例再行肾盂输尿管交界部狭窄手术,3例切除肾脏。结论:经皮肾镜气压弹道碎石取石术后患者肾功能损害最重要的原因仍为肾盂输尿管交界部狭窄,需在取石术时同时手术解除输尿管梗阻,并密切定期术后随访。
OBJECTIVE: To analyze the causes and mechanisms of percutaneous nephroscopic pneumatic lithotripsy on renal function in patients and to seek ways to prevent it. Methods: The clinical data of 11 cases of percutaneous nephrolithotrude pneumatic lithotripsy were retrospectively analyzed, including the clinical data of renal imaging (ultrasound, MRU, IVP) and renal function test (ECT) before and after operation. Results: In 11 patients with severe renal impairment, the renal filtration rate was lower than the normal 20%. ECT showed a low varicosity, IVP was not imaging, 9 cases of severe hydronephrosis, 1 case of no obvious water, 1 case Kidney atrophy, including 7 cases of preoperative ureteropelvic junction stenosis, 4 cases of preoperative stenosis; 8 cases of reoperation ureteropelvic stenosis surgery, 3 cases of excision of the kidneys. Conclusion: The most important cause of renal dysfunction in patients with percutaneous nephrolithotomy is the ureteropelvic junction stenosis. Ureteral obstruction needs to be removed simultaneously with stone removal surgery and follow-up should be performed regularly.