11例婴幼儿孤立肾结石急性梗阻的治疗经验及疗效分析
阿不力克木·吐尔逊" target="_blank">买买提吐尔逊1,阿力木江·阿布来孜2,艾尔肯·吐尔逊1

1.新疆喀什地区第一人民医院泌尿外科(新疆喀什,844000); 2.伽师县人民医院泌尿外科(新疆伽师,844300); 3.第四军医大学西京医院儿科(陕西省西安市, 710032); 4.暨南大学附属第一医院泌尿外科(广东省广州市,510630)

肾结石; 肾/损伤; 尿路结石; 治疗; 婴儿

Management of calcular obstructed solitary kidney:a report of 11 cases.
Abulikemu Maimaitituerxun1,Alimujiang Abulaizi2,Aierken Tuerxun1,Abudukahaer Batuer1,Sheng Quan Cheng3,Abulimiti Muhetaer1,Caiyong Lai4.

1.Department of Urology,First People's Hospital of Kashgar Area,Kashgar 844000,China; 2.Department of Urology,People's Hospital of Jiashi County,Jiashi 844300,China; 3.Department of Pediatrics,Xijing Hospital,Forth Military Medical University,Xian 710032,China; 4.Department of Urology,First Affiliated Hospital of Jinan University,Guangzhou 510632,China.Corresponding author:Abudukahaer Batuer,Email:27743432@qq.com

Kidney Calculi; Kidney/IN; Urinary Calculi; Therapy; Infant

DOI: 10.3969/j.issn.1671— 6353.2018.06.013

备注

目的 探讨婴幼儿先天性孤立肾结石梗阻致急性肾损伤的病因、急诊处理方法及疗效。方法 回顾性分析11例婴幼儿孤立肾结石梗阻性急性肾损伤病例资料。其中肾结石2例,肾结石并输尿管结石5例,输尿管下段结石4例(合并膀胱多发结石1例); 阳性结石5例,阴性6例; 术前平均血尿素氮(BUN)(21.85±8.88)mmol/L; 平均血肌酐(Cr)(276.73±127.52)μmol/L,结石直径(8.64±202.64)mm。结果 本组3例经保守治疗后症状缓解,其中1例自行排出结石; 1例3个月后肾积水加重,予输尿管钬激光碎石及双J管内引流术; 1例于保守治疗出院后1个月因再次无尿行急诊开放手术。全组病例中,行急诊开放手术3例; 急诊输尿管镜下双J管内引流术6例,其中4例行二期输尿管镜碎石术。全组11例均治愈,无一例发生围手术期严重并发症或死亡。术后平均随访时间2～15个月,结石排净率为100%,均肾积水消失,肾功能恢复正常。结论 对于婴幼儿先天性孤立肾结石梗阻性急性肾损伤,应首选急诊微创手术治疗,及时解除梗阻,恢复肾功能。
Objective To evaluate the etiology,management and efficacy of calcular obstructive acute kidney injury with solitary kidney in infants. Methods Retrospective analyses were performed for the clinical data of 11 infants with calcular obstructed AKI and solitary kidney.There were kidney stone(n=2),kidney & ureteral stone(n=5)and lower ureteral stone(n=4)(including 1 case with current bladder stone),radiopaque stones(n=2)and radiolucent stones(n=9).Preoperation mean level of blood urea nitrogen(BUN)was(21.85±8.88)mmol/L,mean(Cr)level was(276.73±127.52)μmol/L and stone size(8.64±202.64)mm. Results The symptoms abated in 3 cases after conservative measures. And one of them discharged kidney calculi by himself. The severity of hydronephrosis was greater in one of them after 3 months. Ureteral holmium laser lithotripsy and double J stenting were performed. Three patients underwent open surgery and 6 had DJ stenting.Then 4/6 cases underwent two-phase ureterocopic lithotrity. No other serious complications or death occurred during the perioperative period. Postoperative follow-ups lasted 2-15 months. All renal functions recovered with a stone-free rate of 100%. Conclusion For infants with calcular obstructed AKI and solitary kidney,emergent endoscopic management should be attempted as a first choice to relieve obstruction without delay and protect renal function.