经肾段间隙肾实质切开取石术治疗复杂性鹿角状肾结石  

Renal parenchyma incision of convex margin between segment for removal of complex staghorn renal stone

作　　者：夏维木[1] 徐玉生[1] 叶祥燕[1] 胡卓晖[1] 

机构地区：[1]中国人民解放军第184医院泌尿外科,鹰潭335000

出　　处：《江西医药》2005年第10期594-596,共3页Jiangxi Medical Journal

摘　　要：目的报告经肾段间隙肾实质切开取石术治疗复杂性鹿角状肾结石以减少肾脏损伤的疗效。方法沿肾外侧缘肾段间隙肾实质切开术式治疗复杂性鹿角状肾结石102例。具体方法:患复杂性鹿角状结石的肾脏表面常常有着明显的肾段之间白色分界线,在肾外侧缘沿此段间线用手术刀背钝性切开肾实质及锐性切开肾盏、肾盂至完全能取出结石,冲洗肾盏、肾盂,可吸收线缝扎明显的出血血管,对肾盏、肾盂进行整形缝合形成一个宽大的肾脏收集系统,肾实质之间置入带蒂的肾周脂肪,缝合肾包膜。结果102例均一次取净结石。术中输血13例,平均输血150ml;术后1d尿液变清;术后6周复查KUB+IVU,手术侧显影正常,积水减轻,无肾盏狭窄及结石残留。结论经肾外侧缘肾段间隙肾实质切开取石术具有术中、术后出血少,手术创伤小,肾功能损害轻,手术操作简便,取石时间短,术中显露好,便于一次性取净结石等优点,适用于治疗各种肾盂肾盏复杂性鹿角状结石。Objective To evaluate the renal parenchyma incision of convex margin between segment for removal of complex staghorn renal stone. Methods Parenchyma incision of convex margin between segment was used to remove stones in 102 patients with complex staghorn renal caliculi.The procedure was as follows： It often has transparent dent--line between segment on the surface of kidney with staghom caliculi. Blunt incision of renal parenchyma and sharp incision of calyx were made on lateral border along the line. as for the complex staghorn renal stone can be removed completely. Whether the renal pedicel clamp was used according to the bleeding of the incision .The calyx and pelvis were flushed with saline,and then the bleeding vessels was sutured and the open calyx and pelvis were repaired to be a broad collection system. Pedicel perirenal fat was put on the incision of renal parenchyma and then the capsular was sutured. Results The calculi were completely removed in all the 102 cases,13 cases needed intraoperative blood transfusion and the mean amount of blood was 150ml.The urine was clean one day postoperatively; KUB＋IVU were normal 6 weeks postoperatively with improved hydronephrosis,no intrarenal stricture and residual calculi.Conclusion This procedure has the advantage of little intraoperative and postoperative bleeding,slight impairment of renal function,little operating time, convient procedure, good exposure and indicated for the removal of any complex renal staghorn stones.

关 键 词：肾结石 外科手术 

分 类 号：R692.4[医药卫生—泌尿科学]