鹿角形肾结石的治疗

The treatment of renal staghorn calculi

目的 探讨经肾窦内肾盂切开和 /或气压弹道碎石治疗鹿角形肾结石的疗效。方法 对 6 8例、80个肾鹿角形结石采用在肾窦脂肪包膜与肾盂外膜之间的疏松结缔组织内充分分离达肾乳头 ,切开肾盂 ,并向肾窦内肾盂扩大的手术方法。对完全性鹿角形结石 ,结合气压弹道碎石 ,将结石分解成几块 ,再逐一取出。双侧肾结石采用一次分侧手术取石。结果 34个部分鹿角形肾结石均完整取出 ,4 6个完全性鹿角形肾结石亦较顺利地取出。结论 ①熟悉肾窦肾盂的解剖结构 ,术中充分分离肾窦内肾盂是取出鹿角形结石的关键。②对巨大的完全性鹿角形结石 ,采用气压弹道碎石是较好的方法。③双侧肾结石多有梗阻致肾功能受损 ,应双侧一次取石 ,有利于双肾功能恢复。分次手术应在

Objective To study the effects of intrasinusal pyelolithotomy and/or with ballast lithotripsy (BL) in the treatment of staghorn calculi. Methods A total 80 kidneys of 68 patients, after full separation of the intrasinusal pyelolithy to the papilla, the partial staghorn calculi were taken out through intrasinusal pyelolithotomy; the huge staghorn calculi were taken out one by one with BL to break the whole into several. Results Thirty four partial staghorn calculi were successfully taken out and 46 huge staghorn calculi were smoothly removed. Conclusion ① The key to taking out the calculi is to know the anatomy of the intrasinusal pyelolithy and to expose fully intrasinusal pyelolithy at operation; ② It is better that the huge staghorn calculi are broken into several with BL. ③ One stage lithotomy on both sides should be performed on the bilateral renal stone.For renal harmful due to calculi and obstruction, staged lithotomy should be performed after two weeks.