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目的探讨微创手术治疗上尿路结石致急性梗阻性肾功能不全、肾积脓感染的临床效果。方法回顾性分析2009年5月至2012年9月收治的30例上尿路结石所致的急性上尿路梗阻性肾功能不全患者。30例均合并肾积脓感染,其中予以急诊行输尿管镜下逆行插管引流21例,经皮肾穿刺造瘘9例,配合全身应用三代头孢抗生素治疗。术前及术后记录生命体征及尿量变化,检查血像及肾功能等指标。结果全部输尿管逆行插管引流术和经皮肾造瘘术均顺利完成,所有患者均成功解除了尿路梗阻,无邻近脏器损伤或大出血、败血症等严重并发症。术后生命体征改善,急诊解除梗阻后血尿素氮(BUN)由(23.2±3.8)mmol/L降至(5.6±2.2)mmol/L、血清肌酐(Scr)由(472.3±142.5)μmol/L降至(54.8±22.3)μmol/L,尿量明显增加,肾功能改善,手术前后比较差异有统计学意义(P<0.01)。结论上尿路结石引起肾功能不全合并肾感染积脓的处理原则是早期解除梗阻,联合全身抗感染治疗。输尿管插管引流术与经皮肾造瘘术均是有效的微创治疗方法。
Objective To investigate the clinical effect of minimally invasive surgery in the treatment of acute obstructive renal insufficiency and pyogenic renal infection caused by upper urinary calculi. Methods A retrospective analysis of 30 patients with upper urinary tract obstruction caused by upper urinary tract stones admitted from May 2009 to September 2012 was performed. Thirty cases were complicated with pyometra pyretic infection, of which 21 cases were retrospectively transurethral ureteroscopic retrograde intubation and drainage, 9 cases were percutaneous nephrostomy, and the third-generation cephalosporin antibiotics were applied to the whole body. Preoperative and postoperative vital signs and urine output changes, check blood and renal function and other indicators. Results All ureter retrograde intubation and percutaneous nephrostomy were successfully completed, and all patients were successfully relieved of urinary tract obstruction, no adjacent organ damage or major bleeding, sepsis and other serious complications. The postoperative vital signs were improved, the blood urea nitrogen (BUN) was decreased from (23.2 ± 3.8) mmol / L to (5.6 ± 2.2) mmol / L and the serum creatinine was (472.3 ± 142.5) μmol / L (54.8 ± 22.3) μmol / L, urine output increased significantly, renal function improved, the difference was statistically significant before and after operation (P <0.01). Conclusion Upper urinary tract stones cause renal insufficiency combined with renal infection empyema treatment principle is the early lifting of obstruction, combined systemic anti-infective therapy. Ureteral catheter drainage and percutaneous nephrostomy are effective minimally invasive treatment.