肾窦内肾盂及肾后唇实质弧形切开取石术治疗复杂性鹿角形肾结石  

Arc renal parenchyma incision of pelvis within renal sinus and renal posterior lib for the removal of complex staghorn renal calculi

作　　者：李化升 甘克定[2] 郑业辉[1] 

机构地区：[1]广西壮族自治区玉林市红十字会医院泌尿外科,537000 [2]广西壮族自治区玉林市红十字会医院外科,537000

出　　处：《中华泌尿外科杂志》2006年第7期443-446,共4页Chinese Journal of Urology

摘　　要：目的探讨肾窦内肾盂及肾后唇实质弧形切开取石术治疗复杂性鹿角形肾结石的疗效。方法采用自行设计的肾窦内肾盂及肾后唇中下1/3肾实质弧形切开取石术治疗复杂性鹿角形肾结石86例97侧；右侧42例,左侧33例,双侧11例。合并输尿管结石17例,肾上盏、中盏和(或)多发性肾结石54例。肾功能不全25例,BUN12.3～76.0mmol/L,Scr 231～1721μmol/L。术中游离肾窦内肾盂后,2-0可吸收线在肾后唇中下1/3肾实质交界处作两排链扣式缝合肾实质全层,达肾下盏大组开口平面后继续弧形向上部作两排链扣式缝合,经肾中盏大组至其开口平面。沿此切口切开肾实质和肾盂及下中肾盏,边切边缝,用肾盂拉钩拉开肾实质即可取净。肾盂、肾盏内结石。结果86例97侧均一次取净结石。手术时间105～187min,平均129min。术中出血量120～460ml,平均220ml。43例输血,输血量120～200ml,平均140ml。术后1个月复查B超和KUB加IVU未见残留结石,肾积水减轻,肾盏颈无狭窄。结论肾窦内肾盂及肾后唇实质弧形切开取石术具有操作简单、安全,术野清晰,出血少,对肾损伤轻,一次性取净肾结石等优点,是治疗复杂性鹿角形肾结石较为理想的方法。Objective To evaluate the arc renal parenchyma incision of pelvis within renal sinus and renal posterior lib for the removal of complex staghorn renal calculi. Methods Arc renal parenehyma incision of pelvis within renal sinus and renal posterior lib was performed to remove stones in 86 cases （97 sides） with complex staghorn renal calculi. Among the 86 cases,42 had stones on the right side; 33, on the left side ; 11, on bilateral sides. Seventeen cases had concomitantly calculi in the ureter, and 54 had calculi in upper and mid calyx or multiple renal calculi. As for comorbidity, 11 cases had hypertensions;4,diabetes; and 5, hepatitis B. Twenty-five cases had renal insufficiency, with BUN of 12.3 - 76.0mmol/L and Cr of 231 - 1721μmol/L. The procedure was performed as follows： the kidney was dissected free and the pelvis within renal sinus was isolated. Two rows of bottom style sutures were made on the renal parenchyma with 2-0 plain catgut along mid-lower 1/3 of the dorsal surface of kidney free of vessels from the renal posterior lib to the plane of lower major calyx. The renal parenchyma was opened. Then, the incision was developed from the plane of lower through the middle major calyx to the plane of upper major calyx. The renal parenchyma and mid-low calyx along the incision were opened, suturing while incising, so that all the stones could be easily removed with hook. Results The calculi were completely removed in all 86 cases （97 sides）. The operative time was 105 - 187min （mean, 129min）. The intraoperative blood loss was 120 -460 ml （mean,220 ml）. Forty-three cases needed intraoperative blood transfusion of 120 -200 ml （mean, 140 ml）. One month after operation,KUB ＋ IVU and ultrasonic findings were normal with improved hydronephrosis,no intrarenal stricture and no residual calculi. Conclusions This procedure has the advantages of less bleeding, slight impairment of renal function, simple handling, clear operative field, high clearance rate, therefore is indicated for the removal o

关 键 词：肾结石 外科手术 

分 类 号：R699[医药卫生—泌尿科学]