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目的探讨双侧上尿路结石所至梗阻性肾衰的临床治疗方法。方法回顾性总结分析我院自2005～2010年共收治的15例双侧上尿路结石所至梗阻性肾衰患者的临床资料,其中10例应用双侧输尿管镜下气压弹道碎石术并置入双J管治疗,3例行一侧输尿管镜下气压弹道碎石加同期对侧输尿管切开取石术,2例行一侧输尿管镜下气压弹道碎石术术后2周行对侧输尿管切开取石术。结果碎石成功后均留置双J管,2例因输尿管开口严重狭窄而插镜失败。所有病例手术后均出现多尿期,3 d内肾功能均能明显好转,6例7～10 dBun、Cr均恢复正常,9例明显改善,随访3个月后仍有不同程度氮质血症。结论输尿管镜术具有安全、损伤小、术后恢复快,可同时处理双侧病等特点,有条件时应作为双侧上尿路结石所致梗阻性肾衰中的首选治疗方法。
Objective To investigate the clinical treatment of obstructive renal failure caused by bilateral upper urinary tract calculi. Methods The clinical data of 15 patients with obstructive renal failure from bilateral upper urinary calculi treated in our hospital from 2005 to 2010 were retrospectively analyzed and summarized. Among them, 10 cases were treated with bilateral ureteroscopic pneumatic lithotripsy Into double J tube treatment, 3 cases of ureteroscopic pneumatic lithotripsy and contralateral ureteral incision and lithotomy, 2 cases of bilateral ureteroscopic pneumatic lithotripsy 2 weeks after the contralateral ureteral catheterization Open stone surgery. Results Both stones were placed in double J tube after successful grafting, and 2 patients failed to insert the mirror because of severe stenosis of the ureter. In all cases, polyuria occurred after surgery, and renal function improved significantly within 3 days. 6 cases of 7 ~ 10 dBun and Cr returned to normal, and 9 cases improved significantly. After 3 months of follow-up, there were still varying degrees of azotemia . Conclusions Ureteroscopy has the characteristics of safety, less damage, quick recovery after operation, simultaneous treatment of bilateral disease and the like, and should be the first choice of treatment for obstructive renal failure caused by bilateral upper urinary calculi when possible.