肾盂肾实质联合切开术治疗复杂性肾结石42例临床分析

Renal Parenchyma Incision of Pelvis and Renal Posterior Lip for the Removal of Complex Renal Calculi

目的探讨开放性手术治疗复杂性肾结石的方法及疗效。方法采用肾盂加肾后唇肾实质联合切开的方法治疗复杂性肾结石42例,其中11例采用低温下肾动脉阻断法;26例采用两排扣锁式肾实质全层缝合法切开肾实质;5例直接切开肾实质,然后从肾中下1/3交接处向肾下盏作一斜形切口,即可在直视下探查各肾盏取出结石,肾盂肾实质分层缝合。结果36例结石一次完全取净,6例有1～3粒不等的残留小结石,经体外冲击波碎石治愈。结论肾盂加肾后唇肾实质联合切开术具有结石取净率高,肾功能损害轻,并发症少等优点,是治疗复杂性肾结石较为理想的方法。

Objective To explore the way and the effect of open-style treatment for complex renal calculi. Methods 42 cases of complex renal calculi were manipulated by incising the pelvis and the renal parenchyma of renal posterior lip. Parenchymal radial incisions of the renal posterior lip were made in the junction between middle and lower part of the kidney. In all the cases, 11 parenchymal incisions were created by stopping kidney artery in a low temperature;26 incisions were made between two lines of button-lock sutures in renal parenchyma;5 incisions were directly made in the renal parenchyma. After incisions of the pelvis and the renal posterior lip were made, exploration of calyces was completed and stones were removed under direct vision. Incisions of the pelvis and the parenchyma were separately sutured. Results 28 cases presented stone-free, 1 - 3 small residual calculi frag- ments were treated by ESWL in 6 cases. Conclusions Renal parenchyma incision of pelvis and renal posterior lip has the advan- tages of higher stone removal rate, of minor renal function damage and of lower complication rate. The procedure is an optimal way to handle complex renal calculi.