后腹腔镜下无萎缩肾切开取石术治疗鹿角形肾结石  

Clinical Study of Laparoscopic Nephrolithotomy in Treatment of Complex Renal Calculi

作　　者：杜博森 李云飞 石昌健 许杰 周本锐 苏洋 DU Bo-sen;LI Yun-fei;SHI Chang-jian;XU Jie;ZHOU Ben-rui;SU Yang(Department of Urology,Renmin Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]湖北医药学院附属人民医院泌尿外科,湖北十堰442000

出　　处：《湖北医药学院学报》2024年第2期157-160,共4页Journal of Hubei University of Medicine

摘　　要：目的:探讨腹腔镜下无萎缩肾切开取石术(laparoscopic nephrolithotomy,LANL)治疗复杂性肾结石的可行性。方法:回顾性分析我院2017年1月至2023年1月16例LANL患者的临床资料。所有患者术前均行CT平扫+尿路成像(CTU)以明确结石的数量、大小、形状、肾盂形态及肾积水的程度。记录患者术前肾功能情况,并与术后24 h肾功能进行比较。同时记录手术时间、术中肾蒂阻断时间、术中出血情况、术后结石残留率及术后并发症。结果:16例手术均获成功,无一例中转开放。手术平均时间(160.0±31.2)min;肾脏热缺血平均时间(24.8±2.8)min;术中平均出血量(142±55)mL;术后引流管留置时间(5.44±1.46)d,术后平均住院时间(7.50±0.89)d。术后仅2例有结石残留,结石清除率为87.5%(14/16)。所有患者均无漏尿、出血及尿源性脓毒血症发生。患者术后1月随访GFR水平较术前显著升高(P<0.05)。术后中位随访17.75个月,CTU显示患肾梗阻程度明显减轻。结论:经合理筛选适应证及丰富腹腔镜手术经验前提下,后腹腔镜LANL是一种安全、有效的微创方法,其单次清石率高,尤其适于需单次处理的复杂性肾结石。Objective To explore the feasibility of laparoscopic non-atrophic nephrolithotomy(LANL)in the treatment of complex renal calculi.Methods The clinical data of 16 patients with LANL in our hospital from January 2017 to January 2023 were retrospectively analyzed.Preoperative CT plain scan+urinary tract imaging(CTU)were performed on all patients to determine the number,size,shape,renal pelvis morphology,and degree of hydronephrosis of the stones.The preoperative renal function of patients was recorded and compared with postoperative 24-hour renal function.Surgical time,intraoperative renal artery clamping time,intraoperative bleeding,postoperative residual stone rate,and postoperative complications were also recorded.Results All 16 surgeries were successful without any cases of conversion to open surgery.The average surgical time was(160.0±31.2)min;average renal warm ischemia time was(24.8±2.8)min;average intraoperative blood loss was(142±55)mL;duration of drainage tube placement postoperatively was(5.44±1.46)d,average length of hospital stay postoperatively was(7.50±0.89)d.Two patients had residual stones postoperatively,resulting in a stone clearance rate of 87.5%(14/16).There were no cases of urinary leakage,bleeding,or urosepsis.GFR levels in patients significantly increased at 1-month follow-up postoperatively compared to preoperative levels(P<0.05).At a median follow-up of 17.75 months postoperatively,CTU showed a significant reduction in the degree of kidney obstruction in the patients.Conclusion Under the premise of appropriate screening of patients and rich experience in laparoscopic surgery,retroperitoneal LANL is a safe and effective minimally invasive method.Its high single-session stone clearance rate makes it particularly suitable for managing complex kidney stones that require single-session treatment.

关 键 词：腹腔镜 肾实质切开取石 肾结石 铸型结石 

分 类 号：R699.2[医药卫生—泌尿科学]