摘要
目的本文借鉴Boyce-Smith的经验,提出对无萎缩性肾切开取石术的改进和创新,试图在治疗肾铸型多发性结石这一方面探讨一种更具安全性和实用性且便于在基层医院推广应用的手术方法。方法采用改良无萎缩性肾切开术治疗肾铸型多发性结石8例。常温下不阻断肾蒂血流,应用手法阻滞肾后动脉显示段间线,尔后根据每一例肾结石实际情况决定选择性行前后段间线、后基段间线、后尖段间线单独或联合的肾切开取石。术后一般留置输尿管导管内引流外置固定,肾旁留置思华龙硅胶管引流。结果本组35例均一次取净结石。手术入路采用前后段间线切开5例、后基段间线切开22例、后基段间线加前后段间线9例,其中6例再加后尖段间线切开。术中输血17例,平均输血350ml。腰部伤口全部一期愈合,无尿瘘发生。外置输尿管导管内引流术后7至9天拔除,平均住院14日。本组未见术后继发感染或者出血。术后半年21例KUB、IVU复查,术侧肾脏显影良好,未见残存结石。结论改良无萎缩性肾切开术,具备简便易行、安全可靠和成功率较高的特点。本文提出选择性行段间线切开,可减少不必要的肾损伤,最大限度地保护肾功能。外置输尿管导管作内引流不但免除术后经膀胱镜取管的麻烦,而且节省了医疗费用。
Objective Purpose In order to discuss a operative method that was more safe and practical , easy to popularize in the base hospital. This essay used the experience of Boyce-Smith, put forward methods to improve and bring forth new ideas to Anatrophic Nephrolithotomy. Method 8 cases of gaint staghorn and multiple renal calculi were treated by Anatrophic Nephrolithotomy. In normal -temperature didn抰 block renal vascular, transient interruption of the posterior segmental renal artery by maneuver. Then we decided to choose single or unite nephrolithotomy at the former and posterior intersegmental line, the posterior basal segment line, the posterior sharp segment line on the basis of each case’s renal calculi in fact. We put aside internal ureters stent after operation, sihualong stent near renal. Results 35 cases were treated with one time nephrolithotomy. The operative method was that nephrolithotomy at the former and posterior intersegmental line were 5 cases, the posterior basal segment line were 22 cases, both them were 9 cases , 6 of them added posterior sharp segment line. 17 cases were treated to transfuse blood in the operation, the blood volume averaged 350ml. The lumbar wound were well. Urinary fistula didn’t happened. Internal ureters stent were pulled out in7-9 days after operation. The days that all cases were hospitalized averaged 14. Infection and hemorrhage were not seen after operation. The visited 21 cases were checked by KUB& IVU after 6 months postoperatively, KUB& IVU indicated normal kidney, no remanent calculus. Conclusions Anatrophic Nephrolithotomy has a simple method of operation. The operation is safe, has high success rate. The ntersegmental line neprotomy decrease hurting kidney, protect the functions of kidney. External ureters stent can avoiding to pull stent from vesica copic, save medical cost.
出处
《国际医药卫生导报》
2005年第8期8-10,共3页
International Medicine and Health Guidance News
