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目的总结微创腔内技术在不同病因引起上尿路梗阻性肾衰的应用。方法针对49例上尿路梗阻性肾衰,其中上尿路结石34例,各种原因引起输尿管狭窄15例。采用输尿管镜下碎石、狭窄气囊扩张、留置双“J”管、微通道经皮肾镜碎石、肾造瘘等手段治疗。结果49例均成功解除梗阻。急性梗阻37例血BUN、Scr恢复正常范围,最快1 d,最慢25 d。慢性梗阻5例肾功能完全恢复,平均时间1.2月;5例部分改善,3个月仍氮质血症期,Scr 186~442μmol/L、BUN 10.7~15.1 mmol/L;2例中途放弃。治愈率85.7%,有效率95.9%。结论腔内技术治疗梗阻性肾衰具有微创、安全、疗效显著,恢复快等优点,术后肾功能恢复情况与梗阻时间成正比关系。
Objective To summarize the application of minimally invasive techniques in the treatment of upper urinary tract obstructive renal failure due to different causes. Methods 49 cases of upper urinary tract obstructive renal failure, including 34 cases of upper urinary tract stones, ureteral stricture caused by various reasons in 15 cases. Ureteroscopic lithotripsy, narrow balloon dilatation, indwelling double “J” tube, micro-channel percutaneous nephrolithotomy, nephrostomy and other means of treatment. Results All the 49 cases successfully relieved the obstruction. Acute obstruction in 37 cases of blood BUN, Scr returned to normal range, the fastest 1 d, the slowest 25 d. The renal function recovered completely in 5 cases of chronic obstruction, with a mean time of 1.2 months. Five cases were partially improved, and three cases of azotemia were still positive. Scr 186 ~ 442μmol / L and BUN 10.7 ~ 15.1 mmol / L respectively. The cure rate is 85.7% and the effective rate is 95.9%. Conclusion Endovascular treatment of obstructive renal failure has the advantages of minimally invasive, safe, significant effect, rapid recovery, postoperative recovery of renal function and obstruction time is proportional to the relationship.