开放手术在复杂肾结石治疗中的临床意义

Clinical significance of open surgery in the treatment of complicated renal calculus

目的探讨开放手术在复杂肾结石治疗中的有效性和必要性。方法回顾分析116例行开放手术治疗复杂肾结石患者的临床资料。结果 116例手术均成功完成。术中并发大出血2例,经输血等治疗恢复。术后无感染性休克等严重并发症发生。15例患者伴结石残留,其中7例患者有少量小结石残留,后期排石治疗;2例患者残留少量结石位于两极肾盏憩室内,未进一步处理;6例患者需进一步碎石治疗。术后随访0.5-3.0年,患肾功能均有明显恢复,肾脏积水均明显减轻。结论开放手术治疗复杂肾结石安全有效,可作为微创方法失败后的补救方案,在伴随解剖结构异常等特殊情况下将成为复杂肾结石治疗的必要手段。

Objective To investigate effectiveness and necessity of open surgery in the treatment of complicated renal calculus. Methods Clinical data of 116 complicated renal calculus patients who received open surgery were retrospectively analyzed. Results All the 116 patients received successful operation. There were 2 cases with complicated intraoperative massive haemorrhage, and they recovered after blood transfusion. There was no case with severe complications of postoperative septic shock. Among 15 cases with complicated residual calculus, there were 7 cases receiving calculus removing due to small residual calculus, 2 cases with few residual calculus inside calyces diverticulum without further treatment, and 6 cases in need of further lithotripsy. Postoperative follow-up for 0.5-3.0 years showed obviously improved renal function and reduced hydronephrosis. Conclusion Open surgery is safe and effective in treating complicated renal calculus, and it can be applied as rescue regimen for failed minimally invasive operation. This method is necessary in treating complicated renal calculus along with special condition, such as anatomical deformity.