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目的总结上尿路梗阻性无尿的病因,并根据目前条件提出合适的急诊处理方案。方法96例上尿路急性梗阻致肾后性肾功能衰竭,54例行膀胱镜下输尿管逆行插管(RCU),22例行经皮肾穿刺引流(PCN),11例行开放手术(OS),6例行血透,32例行输尿管镜气压弹道碎石术(URSL),2例行急诊体外震波碎石(ESWL)。结果①梗阻原因:结石梗阻87.5%,肿瘤侵犯占6.3%,医源性占4.2%。②处理结果:RCU、OS、PCN、URSL、和ESWL成功率分别为66.7%、90.9%、100%、78.1%和50.0%。解除梗阻93例,成功率为96.9%;2例死亡,死亡率2.1%;2例透析维持。结论上尿路急性梗阻性无尿的病因绝大多数是结石梗阻,其次为肿瘤侵犯和手术并发症。外科急诊应尽早明确诊断并尽快处理.治疗方法应首先选用RCU、PCN等方法引流肾盂尿液,全身情况许可者可采用URSL、ESWL或OS解除梗阻;肾功能差、全身情况不良者,则可在RCU、PCN或透析后再进一步解除梗阻.各种处理方法均应结合病情,避免并发症的发生。
Objective To summarize the etiology of obstructive anuria on the urinary tract and to put forward the appropriate emergency treatment plan according to the current conditions. Methods Ninety-six cases of upper urinary tract obstruction caused by renal proximal renal failure, 54 cases underwent cystoscope ureteral retrograde intubation (RCU), 22 cases underwent percutaneous renal puncture and drainage (PCN), 11 cases underwent open surgery (OS) , 6 hemodialysis, 32 ureteroscopic pneumatic lithotripsy (URSL) and 2 emergency ESWL. Results ① obstruction causes: stone obstruction 87.5%, tumor invasion accounted for 6.3%, iatrogenic accounted for 4.2%. ②Results: The success rates of RCU, OS, PCN, URSL and ESWL were 66.7%, 90.9%, 100%, 78.1% and 50.0% respectively. 93 cases were relieved of obstruction, the success rate was 96.9%; 2 died, the mortality rate was 2.1%; 2 cases were maintained by dialysis. Conclusion The most obstructive anuria of the upper urinary tract is stone obstruction, followed by tumor invasion and surgical complications. Surgical emergency diagnosis should be as soon as possible and be treated as soon as possible. Treatment should be the first choice of RCU, PCN and other methods of drainage of pelvic fluid, the general permit may URSL, ESWL or OS to lift the obstruction; poor renal function, general condition may be poor Obstruction is further relieved after RCU, PCN or dialysis.All treatments should be combined to prevent the occurrence of complications.