4种术式治疗孤立肾复杂性结石比较(附72例报告)

Comparation of Four Different Operation for Solitary Kidney Complicat ed Nephrolithiasis (A Report of 72 Patients)

目的 探讨治疗孤立肾复杂性结石的适宜手术方式。 方法 回顾性分析肾窦内肾盂切开取石术 (术式 1)、肾盂、肾实质切开取石术 (术式 2 )、无萎缩性肾实质切开取石术 (术式 3)、肾盂切开气压弹道碎石术 (术式 4 )等 4种不同术式治疗 72例孤立肾复杂性结石的临床资料 ,依据手术时间、术后住院天数、住院费用、结石清除率、手术并发症及肾功能改善情况评价其优缺点。 结果 术式 1、2、3、4中结石清除率分别为 93.75 % (15 / 16 )、88.2 3% (15 / 17)、84 .6 1% (11/ 13)、96 .15 % (2 5 / 2 6 ) ,输血例数分别为 0、6、8、0例 ;2 1例肾功能不全患者分别采用术式 2、3、4 ,其手术后肾功能恢复时间分别为 3月、3月、2周。 结论 肾窦内肾盂切开取石术是治疗孤立肾中小型复杂性结石的基本方法之一 ,肾盂切开气压弹道碎石术是治疗巨型复杂性孤立肾结石的最佳手术选择。

Objective To study the suitable operative pr oc edure for the solitary kidney complicated nephrolithiasis. Methods The clinical data was retrospectively analyzed of 72 patients who had been diagnosed as the solitary kidney complicated nephrolithiasis. Four kinds o f operation were applied, those were intrasinusal pyelolithotomy (operationⅠ), intrasinusal pyelolithotomy and nephrolithetomy (operationⅡ), anatrophic nephro lithotomy (operation Ⅲ), pyelolithotomy with ballast lithotripsy (operation Ⅳ) . The operation time, cost and hospital stay, the stone clearance rate, complica tions and the renal function progress were compared. Results In operation Ⅰ、Ⅱ、Ⅲ、Ⅳ,the stone clearance rate were 93.75%、88.23%、 84.61%、96.15% respectively; the cases which needed intraoperative blood transfu sion were 0、6、8、0 respectively. In operation Ⅱ、Ⅲ、Ⅳ, the duration of rena l function recovery of 21 renal dysfunction cases were 3 months、3 months、2 wee ks respectively.Conclusion The operation Ⅰ is the basic choice for the small and medium calculi,and the operation Ⅳ is the be st one for the giant staghorn calculi or multiple renal calices calculi of solit ary kidney.