镰刀状肾实质切开术治疗复杂性鹿角状肾结石  

Sickle renal parenchyma incision for the removal of complex staghorn renal stone

作　　者：杨嗣星[1] 王玲珑[1] 詹炳炎[1] 张孝斌[1] 刘修恒[1] 张杰[1] 胡云飞[1] 甘万崇[2] 

机构地区：[1]武汉大学人民医院泌尿外科,430060 [2]武汉大学人民医院放射科,430060

出　　处：《中华泌尿外科杂志》2003年第2期87-89,共3页Chinese Journal of Urology

摘　　要：目的　探讨镰刀状肾实质切开术治疗复杂性鹿角状肾结石的疗效。　方法　采用自行设计的镰刀状肾实质切开术式治疗复杂性鹿角状肾结石 3 7例。具体方法 :分离肾窦内肾盂后 ,用 2 0肠线在肾后唇中下 1/3连接处作两排扣锁式缝合肾实质全层 ,达肾大盏下组开口平面 ,继续用 2 0肠线斜行向中上部作两排扣锁式缝合 ,斜形向上的肾实质切口经肾大盏中组开口平面达肾大盏上组开口平面。肾实质切口形状类似镰刀状 ,沿此切口切开肾实质及肾盂和各组肾盏 ,即可取净各肾盏及肾盂内结石。　结果　 3 7例均一次取净结石。术中输血 2 1例 ,平均输血 12 0ml;术后 4周KUB +IVU复查 ,手术侧肾脏显影正常 ,积水减少 ,无肾盏狭窄及结石残留。　结论　镰刀状肾实质切开取石术具有术中出血少、肾功能受损轻、便于一次取净结石等优点 。Objective To evaluate the sickle renal parenchyma incision for the removal of complex staghorn renal calculi. Methods Sickle parenchyma incision was used to remove stones in 37 patients with complex staghorn renal calculi.The procedure was as follows:the kidney was disected free and the pelvis within sinus renalis was isolated.Two rows of botton 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 (Brodie's line) 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 major calyx through the middle major calyx to the plane of upper major calyx.The shape of this incision appeared like a sickle.The renal parenchyma and each calyx along this incision were opened and so was all the stones could then be easily removed.The calyces could well be observed. Results The calculi were completely removed in all the 37 cases.21 needed intraoperative blood transfusion and the mean amount of blood was 120 ml.KUB+IVU were normal 4 weeks postoperatively with improved hydronephrosis,no intrarenal stricture and void of residual calculi. Conclusions This procedure has the advantages of little intraoperative bleeding,slight impairment of renal function,high clearence rate and is indicated for the removal of any intrarenal pelvis complex staghorn calculi.

关 键 词：镰刀状肾实质切开 治疗 鹿角状肾结石 

分 类 号：R692.4[医药卫生—泌尿科学]