后腹腔镜下肾门后唇加肾窦内肾盂联合切开治疗肾盂鹿角形结石临床效果观察

The clinical effect of retroperitoneal laparoscopic combined incision of posterior lip of renal hilum and intrarenal sinus in the treatment of patients with staghorn calculi of renal pelvis

目的观察后腹腔镜下肾门后唇加肾窦内肾盂联合切开治疗肾盂鹿角形结石临床效果。方法 52例肾盂鹿角形结石患者,均行后腹腔镜下肾门后唇加肾窦内肾盂联合切开术,观察临床疗效。结果 52例均顺利取石,并且未阻断肾蒂,术后未予外引流术治疗;切开肾脏实质(1. 35±0. 17) cm,手术时间(149. 12±16. 78) min,术中出血量(189. 64±21. 39) ml,3例术中输血,平均(400. 12±45. 63) ml,18例联合4~8 cm小切口取石,12例联合膀胱镜软镜取石,41侧一次性取净,12侧残余小结石,3例体外冲击波碎石术治愈,7例二期软镜取尽结石,2例保守观察排石治疗,肾盂输尿管连接部狭窄3例+马蹄肾1例均一期完成肾盂输尿管成形术,并且切口I期愈合;术后(4. 12±0. 42) d引流管拔出,术后7 d尿管拔出,术后2 d下地活动,住院(9. 92±1. 08) d;8例漏尿,其中7例3 d内自愈,1例更换双J管后消失。结论后腹腔镜下肾门后唇加肾窦内肾盂联合切开手术创伤小,患者术后恢复快,具有安全有效特点,可用于治疗鹿角形结石。

Objective To observe the clinical curative effect of retroperitoneal laparoscopic combined incision of posterior lip of renal hilum and intrarenal sinus in the treatment of patients with staghorn calculi of renal pelvis.Methods Fifty-two patients with pelvis staghorn calculi underwent retroperitoneal laparoscopic combined incision of posterior lip of renal hilum and intrarenal sinus.The clinical curative effect was observed. Results All patients had successful stone removal without blocking renal pedicle and external drainage after operation.The dissected renal parenchyma,operation time and intraoperative blood loss were(1. 35±0. 17) cm,(149. 12±16. 78) min and(189. 64 ± 21. 39) ml,respectively. There were 3 cases with intraoperative blood transfusion with average volume of 400. 12±45. 63 mL.There were 18 cases undergoing lithotomy by 4 ~ 8 cm small incision and 12 cases by flexible cystoscopy.There were 41 sides with one-off stone removal and 12 sides with residual small stones.There were 3 cases cured by extracorporeal shock wave lithotripsy,7 cases with all stones removed out by second-stage flexible cystoscope,and 2 cases conservatively observed for stone removal treatment.There were 3 cases with stenosis at pelvic ureter and 1 case with horseshoe kidney completing pyeloplasty in the first stage with incision healed in stage I.The drainage tube was pulled out after(4. 12±0. 42) days of operation.The urethral tube was pulled out on the 7 thday after operation. The ground activity was performed on the second day after operation. The hospitalization time was(9. 92 ±1. 08) days.There were 8 cases with urine leakage.Of them,there were 7 cases self-healed within 3 days,and 1 case disappeared after replacing double-J tube.Conclusion The trauma of retroperitoneal laparoscopic combined incision of posterior lip of renal hilum and intrarenal sinus is small.The postoperative recovery is fast with safety and effectiveness.It can be used to treat staghorn calculi.