肾实质肾盂分层切口治疗复杂性肾鹿角状结石

Layered renal parenchyma and pelvis incisions to remove complex staghorn calculi

目的 :探讨肾实质肾盂分层切口治疗复杂性肾鹿角状结石的效果。方法 :采用肾实质肾盂分层切口治疗复杂性肾鹿角状结石 2 4例。具体方法是作 12肋缘上切口 ,游离肾脏 ,分离肾窦内肾盂 ,用 1— 0合成可吸收缝线在肾中下 1/ 3交界处无血管区从肾后唇向外侧缘作两排扣锁式缝合肾实质全层 ,切开肾实质。从肾上盏颈经肾盂输尿管交界处向肾下盏颈作一弧形切口 ,即可取出结石 ,直视下探查各肾盏 ,用 4— 0可吸收缝线缝合肾盂 ,1— 0可吸收缝线间断缝合肾实质全层。结果 :18例结石一次完全取净 ,其余 6例有 1～ 3粒不等的残留结石 ,经 ESWL治愈。结论 :肾实质肾盂分层切口适用于肾内型肾盂鹿角状结石和复杂多发性肾结石手术。

Purpose: To evaluate the effects of layered renal parenchyma and pelvis incisions to remove complex staghorn calculi. Methods: Layered renal parenchyma and pelvis incisions were used to remove stones in 24 patients with renal staghorn calculi and complex calculi. The procedure was as follows: The incision was performed on the upper edge of the 12th rib, the kidney freed and the pelvis within sinus renalis was isolated. The two row button style sutures was performed on the renal parenchyma by using 1-0 SAS 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 through the convergence of the pelvis to the ureter to the inferior renal calyces neck and the calculi could be easily removed. The various renal calyces were observed under the open surgery. The renal pelvis was sutured by using 4-0 SAS, renal parenchyma interruptedly sutured by 1-0 SAS. Results: The calculi were completely removed in 18 cases. 1 to 3 residual calculi existed in the remaining 6 cases who were cured by ESWL. Conclusions: It was concluded that this procedure was suitable for the removing of intrarenal pelvis complex calculi.