腹腔镜下非萎缩性肾实质切开取石术治疗鹿角形肾结石的初步探讨  

A preliminary study on laparoscopic anatrophic nephrolithotomy for renal staghorn stone

作　　者：钟思文[1] 陈方敏[1] 石家齐[1] 李登宝[1] 孙发[1] 姜锡男[1] 陈绪龙[1] 唐帅[1] 胡瑞洁[1] 陈程[1] 

机构地区：[1]贵州医科大学附属医院泌尿外科,贵阳550004

出　　处：《中华泌尿外科杂志》2016年第7期533-537,共5页Chinese Journal of Urology

基　　金：贵州省卫计委科学技术基金项目（gzwjkj2014-2-119）

摘　　要：目的探讨腹腔镜下非萎缩性肾实质切开取石术治疗鹿角形肾结石的可行性和有效性。 方法回顾性分析2011年5月至2015年1月收治的40例鹿角形肾结石患者的临床资料，男24例，女16例。年龄17～73岁，中位年龄46岁。体重指数18.4～27.3 kg/m2。40例均行腹腔镜下非萎缩性肾实质切开取石术。记录手术时间、术中热缺血时间、术中出血量、结石最大径、结石表面积、无石率、手术并发症发生率、住院时间。比较患者术前及术后6个月的患侧肾小球滤过率（glomerular filtration rate，GFR）、血肌酐（SCr）、肾皮质厚度等。 结果本组40例的手术时间为87～142 min，中位值102.5 min。术中热缺血时间14～36 min，中位值20.3 min。术中出血量20～120 ml，中位值50 ml，无输血病例。无中转开放手术。结石表面积550～1583 mm2，中位值796 mm2。结石最大径34～72 mm，中位值59 mm。住院时间6～12 d，平均（9.2±2.1）d。手术并发症发生率为17.5%（7/40），其中漏尿4例，菌血症3例，无尿源性脓毒血症、延迟性出血等严重并发症，无死亡病例。术后3 d复查KUB或腹部CT，5例有残留结石，于术后3个月行体外冲击波碎石，3例排石效果好，余2例部分排石，一期结石清除率为87.5%。40例均获随访，术后6个月患侧肾GFR较术前下降（13.3±3.7）ml/min，SCr较术前平均下降27.5μmol/L，差异均有统计学意义（P〈0.05）。随访IVU及CT检查示患肾皮质萎缩不明显，肾积水较术前减轻，总肾功能有改善。 结论腹腔镜下非萎缩性肾实质切开取石术治疗鹿角形肾结石是可行的治疗方式之一，具有结石清除率高、术后并发症较少、肾功能影响小等优点。Objective To evaluate the feasibility and effectiveness of laparoscopie anatrophie nephrolithotomy （LAN） managing renal staghorn stone. Methods Forty patients whose age ranged from 17 to 73 years （median 46 years ）, who underwent LAN for renal staghorn stone were included in the retrospective study at Affiliated Hospital of Guizhou Medical University in the period between May 2011 and January 2015, including 24 males and 16 females. The body mass index ranged fromlS. 4 to 27.3 kg/m2. The date of operative time, warm isehemia time, estimated blood loss, mean stone size, stone surface area, stone-free rate, rate of operative complications, postoperative hospital stay was collected. Functional imaging studies including GFR of operated kidney, serum creatinine （5Cr） , renal cortical thickness were obtained before the operation and compared to that of a follow-up of 6 months. Results A total of 40 patients were completed laparoseopically and none required conversion to open surgery. Operative time ranged from 87 to 142 min （median 102. 5 min）. The warm ischemia time ranged from 14 to 36 rain （median 20. 3 rain）. The estimated blood loss ranged from 20 to 120 ml （ median 50 ml）. The mean stone area （SA） ranged from 550 to 1583 mm3 （median 796 mm3 ）. The largest diameter of the stones ranged from 34 to 72 mm （ median 59 mm）. The average postoperative hospital stay was （9. 2 ±2. 1 ） days, ranged from 6 to 12 days. The rate of operative complications was 17.5% （7/40）, including 4 patients got urinary leak and 3 patients with baeteriaemia, no patients showed perioperation urosepsis, delayed renal hemorrhage, death and other severe complication. All patients eleared from their stones except 5 patients had small residual stones managed by extracorporeal shock wave lithotripsy 3 months later, of which three patients had a favorable effect and the last 2 patients got rid of small residual fragments automatically a few weeks later, the stone-free rate was 87.5% determined by KUB or C

关 键 词：肾鹿角形肾结石 腹腔镜下肾实质切开取石术 手术并发症 

分 类 号：R699.2[医药卫生—泌尿科学]