复杂性肾鹿角形结石开放手术

Open operation for complex staghorn renal calculi

目的探讨提高复杂性肾鹿角形结石开放手术治愈率和减少术中、术后并发症。方法对87例复杂性肾鹿角形结石采用肾盂外膜下分离肾窦肾盂,肾中下1/3无血管处排列锁扣式缝合肾实质后唇全层,切开肾实质,并从肾上盏颈至肾下盏颈作一弧形切口取石,部分借助气压弹道碎石等介入技术(简称联合治疗组),与前期无萎缩性肾切开取石术32例(简称对照治疗组)的各项指标进行比较。结果联合治疗组与对照治疗组其术中出血、住院天数、术后肾功能恢复时间、术后短期肾功能损害、结石残留率及术后并发症总发生率分别为(320±78)mL,(420±89)mL;(21±2)d,(24±3)d,(11±7)d,(23±6)d;5.7%,43.8%;9.2%,25%;13.8%,53.10%。两组各项指标差异均有显著性,P值均<0.05。结论复杂性肾鹿角形结石开放手术较理想方法为肾盂肾盏肾中下1/3处肾实质联合切开取石,部分配合气压弹道碎石等介入技术治疗。

[Objective] To evaluate the healing rate and reduce complications in open operation of complex staghorn renal calculi. [Methods] 87 cases of complex staghorn renal calculi accepted to isolate the renal sinus and pelvis. The two row button style sutures were performed on the renal parenchyma at the mid low 1/3 of the kidney free of vessels from the renal posterior lib to the lateral edge. The renal parenchyma was opened. An arc incision was developed from the upper renal calyces neck to the inferior renal calyces neck and the calculi could be removed. Part calculi were removed by interventional technique such as pneumatic lithotripsy etc. （called combining treatment group）. 32 cases were accepted anatrophic nephrolithotomy （called control group）. Compare each index of the two group. [Results] The intra-operative blood, the hospital stay, the postoperative recovery time of renal function, residual rate of calculi and the rate of complications between combining treatment group and control group were respectively （320±78） mL, （420±89） mL; （21±2） d, （24±3） d; （11±7） d, （23±6） d, 9.2%, 25%; 13.8%, 5.10%. There is a significance in difference between each index of the two groups（P 〈0.05）. [Conclusions] More ideal methods in open operation of complex staghorn renal calculi is the mid low 1/3 of the kidney pyelocalycolithotonly and partly with prenumatic lithotripsy for the removal of complex staghorn renal calculi.