肾内型和非肾内型肾盂结石临床对比分析

Comparative Analysis Between the Calculi in Kidney of Intrarenal and Non-intrarenal Pelvis

【目的】比较肾内型和非肾内型肾盂结石的x线影像特征、手术效果、手术情况等供临床参考。【方法】将符合纳入标准的95例118侧肾结石分成肾内型肾盂结石组(A组)和非肾内型肾盂结石组(B组),比较两组的X线影像特征、手术效果、手术情况。【结果】A组结石明显大于B组[(31.86±5.21)mm对(20.35±3.64)mm](P<0.05)。A组铸形结石(47.62%对12.73%,P<0.01)、多发结石(53.97%对20.00%,P<0.01)比率显著高于B组。A组的手术时间[(207±31)min对(121±30)min](P<0.01)、失血量[(173±45)ml对(132±41)ml](P<0.01)、肾实质切开(36.51%对18.18%,P<0.05)和术中肾损伤(25.40%对9.09%,P<0.05)比率均明显大于B组。而A组结石清除率则明显低于B组(80.95%对94.55%,P<0.05),残石率明显高于B组(19.05%对5.45%,P<0.05)。【结论】与非肾内型肾盂结石相比,肾内型肾盂结石位置深、复杂性结石比率高,肾实质切开及术中肾损伤比率高,手术时间长,失血量多,结石清除率低,残石率高。在选择开放手术治疗时,有必要根据X线片区分出肾内型和非肾内型肾盂结石,对肾内型肾盂结石应当更审慎地计划、细心地解剖和轻巧地取石,以避免过多的肾实质切开、失血和肾实质损伤,提高结石清除率,降低残石率。

[Objective]To compare the feature of nephrograms, effect and condition of open surgery between calculi in the intrarenal and non-intrarenal pelvis. [Methods]Ninety-five patients with 118 renal calculi up to standard were included into this study. All patients were divided into group A （ calculi in the intrarenal pelvis ） and group B （ calculi in the non-intrarenal pelvis）. The feature of nephrograms, effect and condition of open surgery between group A and B were compared. [Results]The average size of calculi was （31.86 ±5.21） mm in group A and （20.35±3.64）mm in group B, the difference was significant （ P 〈0.05 ） . The ratios of staghorn calculi and multi-calculi were 47.62% and 53.97% in group A and 12.73% and 20.00% in group B, respectively, the difference was significant （ P 〈0.01 ）. Group A had a longer operative time[（207±31） min vs （121±30）min]（ P〈0.01）, more blood loss [（173±45）ml vs （132±41）ml ]（ P 〈0.01）, more intraoperative renal parenchyma incision （36. 51% vs 18. 18%, P 〈0.05） and injuries（25.40% vs 9. 09%, P〈 0.05）, lower stones free rate （80. 95% vs 94.55%, P〈0.05）, and higher stones residual rate （ 19.05%vs 5. 45% ,P〈0.05）. [Conclusion]It is essential to identify the calculi in the intrarenal and non-intrarenal pelvis by the nephrograms before nephrolithotomy. Careful plans, attentive dissection and skillful removal of calculi in the intrarenal pelvis are necessary to avoid the excess blood loss, intraoperative renal parenchyma incision and injuries, in order to increase the stones free rate and reduce residual rate.