经12肋小切口肾窦内肾盂切开取石术80例

Mini-flank trans-12th rib incision for intrasinusal pyelolithotomy in 80 cases

目的总结经12肋小切口肾窦内肾盂切开取石术的临床应用经验。方法 2005年9月～2010年12月共80例患者接受经12肋小切口肾窦内肾盂切开取石术,对手术入路、临床效果及并发症进行回顾性分析总结。结果 80例手术均获成功,未延长切口。平均手术时间92 min(60～150 min),术中平均出血量102 mL(50～210 mL),均未输血。术后36 h内均恢复进食。2例术后漏尿,分别于5 d、7 d后消失。7例有小结石残留,行体外冲击波碎石和药物排石治疗,结石排出。3例鹿角形结石患者取石时出现肾盂撕裂,借助Fr10导尿管的气囊将回缩的肾盂组织牵出以方便缝合,效果良好。输尿管支架于术后3～4周拔除,拔除后共有62例患者得到继续随访,随访时间为3个月～4年,IVP提示肾盂、输尿管无狭窄,术前肾积水都有不同程度减轻。结论经12肋小切口肾窦内肾盂切开取石术创伤小、恢复快、疗效确切、费用较低,是一种可以选择的微创手术方式。

Objective To report our initial experience of mini-flank trans-12th rib incision for intrasinusal pyelolithotomy. Methods Clinical data of 80 cases of patients with nephrolith underwent intrasinusal pyelolithotomy done through a mini-flank trans-12th rib incision were analyzed retrospectively. Results All the operations went successfully with no extension of the incision. The average operative time was 92 rain （60-150 min）,the mean estimated blood loss was 102 mL （50-210 mL）. All patients resumed oral intake in 36 hours.Leakage of urine happened in 2 cases and respectively disappeared after 5days or 7days.Undetected stones were found on KUB in 7 cases after surgery,which were cured by ESWL and （or） drug.Renal pelvis was splitted in 3 cases of staghorn calculi,then the reconstruction were successfully finished with the help of the ballon of a Fr 10 catheter.Ureter stents were moved 3-4 weeks after the sugery.62 patients have been followed up for 3-48 months,hydronephrosis relieved and no case of pelvis straitness happened. Conclusion Mini-flank trans-12th rib incision offers a new minimally invasive,effective and economic way for intrasinusal pyelolithotomy.