原位无萎缩性肾实质切开取石术治疗巨大肾鹿角形结石体会（附52例报告）  

In situ big dissection of anatrophic nephrolithotomy to remove large renal staghorn calculi： report of 52 cases

作　　者：宋希双[1] 殷积斌[1] 张仁科[1] 车翔宇[1] 何中舟[1] 张志伟[1] 臧青山 

机构地区：[1]大连医科大学附属第一医院泌尿外科,116011 [2]辽宁省抚顺市中心医院泌尿外科

出　　处：《中国医师进修杂志（外科版）》2008年第6期17-19,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨原位无萎缩性肾实质切开取石术治疗巨大肾鹿角形结石的方法和疗效。方法 52例患者，术前评估包括尿常规、尿细菌培养、肾功能、彩色多普勒超声、CT、立位腹部X线平片（KUB）和IVU检查。术中腰部第11肋间切口入路，充分游离肾脏，原位低温阻断肾蒂后，于相对无血管区大切口切开肾实质、肾盏、肾盂，取出结石，重建集合系统，缝合肾实质，恢复肾脏血供。术中采用肾功能保护措施。术后随访包括尿常规、肾功能、彩色多普勒超声、KUB、IVU和核素肾扫描。结果手术时间（117±45）min。肾缺血时间（29±15）min。术中输血5例，平均输血230ml。结石残留4例，结石清除率92.3％。术后均无近期并发症，随访肾功能均正常。结论原位无萎缩性肾实质切开取石术是治疗巨大肾鹿角形结石安全有效的方法，术后并发症少，结石一次性取出、清除率高，术后复发率低。经过系列肾功能保护处理，对肾功能损害小，部分病例避免了肾切除。Objective To discuss the method and effect of large renal staghorn calculi by anatrophic nephrohthotomy（AN ）. Methods Fifty-two patients with large renal staghorn calcuh underwent AN. Bilateral renal calculi disease was present in 3 patients, so that a number of 55 procedures were operated. Preoperative evaluation included urinalysis, urine culture, renal function, and ultrasound, CT, KUB and IVU： A flank incision was between the 1 lth and 12th ribs and the kidney was freed. After interrupted renal pedicle in situ hypothermia, the renal parenchyma incision was made along the avascular plane which is outside in the back of the kidney. The collecting system was opened. The calculi were removed. The collecting system was reconstructed. The renal parenchyma was closed and the renal circulation was reestabhshed. The protected management of renal function was made intraoperative. Postoperative follow- up consisted of urinalysis, renal function, ultrasound, KUB, IVU and ECT. Results The operative time was （ 117 ± 45 ） minutes. The renal ischemia time was （ 29 ±15 ） minutes. Five cases underwent blood transfusion. Mean amount of blood transfusion was 230 ml. Four cases had remained calculi. The stone-free rate was 92.3%. No recent complication occurred after operation. Postoperative follow-up indicated that renal function was normal. Conclusions AN is the most appropriate method for patients with large renal staghorn calcuh because of the highest stone-free rate, the lowest stone-recurred rate and a safe and effective operative procedure with less complication. Renal function damages just little through a series of protected management. Nephrectomy is avoided to part of patients.

关 键 词：肾结石 无萎缩性肾切开取石术 临床分析 疗效 

分 类 号：R692.4[医药卫生—泌尿科学] R259.733.2[医药卫生—外科学]