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目的:探讨经皮肾穿刺造瘘(PCN)在梗阻性肾功能不全诊治中的临床价值。方法:对49例梗阻性肾功能不全患者在B超引导下行PCN引流肾积水(脓),经造瘘管造影了解梗阻原因及部位,病情好转稳定后手术解除梗阻。结果:45例患者经引流后BUN、Cr均有下降,手术解除梗阻后恢复好。4例患者经引流后BUN、Cr无明显下降,继续行血透治疗。无死亡病例。结论:在梗阻性肾功能不全的诊治中,PCN能尽快引流肾积水(脓),改善肾功能,避免血液透析或减少血透次数,减轻患者经济负担;可动态监测肾功能变化,避免治疗上的盲目性;建立的通道为二期手术打开方便之门,尤其是结石梗阻性肾功能不全诊治具有重要的应用价值;使急症手术变为择期手术,降低了手术死亡率及术后并发症发生率;同时经肾造瘘管造影可提高诊断符合率。这种方法微创安全,简单有效,经济实惠,值得推广。
Objective: To investigate the clinical value of percutaneous nephrostomy (PCN) in the diagnosis and treatment of obstructive renal insufficiency. Methods: Forty-nine patients with obstructive renal insufficiency underwent PC-guided drainage of hydronephrosis (pus) guided by B-ultrasound. The cause and site of obstruction were determined by fistulostomy. Results: After the drainage, all 45 patients had decreased BUN and Cr, and recovered well after the operation was relieved. After 4 cases of patients with BUN, Cr no significant decline, continue hemodialysis treatment. No deaths. Conclusion: In the diagnosis and treatment of obstructive renal insufficiency, PCN can drain hydronephrosis (pus) as soon as possible, improve renal function, avoid hemodialysis or reduce the number of hemodialysis, and reduce the economic burden on patients; it can monitor renal function changes dynamically and avoid treatment On the blindness; the establishment of the channel to open the door for the second phase of surgery, especially stone obstructive renal failure diagnosis and treatment has an important value; the emergency surgery into elective surgery, reducing the surgical mortality and postoperative complications Incidence; at the same time by renal fistulography can improve diagnostic accuracy. This method minimally invasive safety, simple and effective, affordable, it is worth promoting.