摘要
目的探讨肾盏切开联合经肾实质气压弹道碎石治疗复杂鹿角形结石的疗效。方法电刀切开积水较重的肾盏,气压弹道碎石杆对准结石碎石后分块取出。盏颈口狭窄但肾盏积水不严重者,将直径1 mm气压弹道碎石杆于肾实质处刺入结石位置,将肾盏内结石击碎后从盏颈口取出。结果19例均未阻断肾蒂,手术时间90-150 min,平均120 min。术中出血量100-250 ml,未输血。17例一次取石成功,术后无结石残余;1例术中残余泥沙状结石,术后经肾造瘘管冲洗引流排出;1例肾盏结石术中取石遗漏,术后经ESWL碎石后排净结石。15例随访10-60个月,平均18个月,结石复发2例,体外震波碎石后排净结石。结论肾盏切开联合经肾实质气压弹道碎石治疗复杂性鹿角形结石出血少,疗效可靠。
Objective To evaluate the efficacy of calicecotomy combined with trans-renal parenchyma pneumatic lithotripsy for complicated staghorn renal calculi. Methods The severe hydrocalycosis was incised using electrocautery, then pneumatic lithotripsy was performed and the broken stones were taken out. For those patients with stenotic entrance to renal calyces without hydrocalycosis, we stabbed into the stones with the lithotriptic pole（ 1 mm in diameter） through renal parenchyma and took the broken stones out of the entrance. Results The renal pedicle were not blocked in 19 cases. The operation time was 90 - 150 minutes, with a mean of 120 minutes. There was no blood transfusion with the blood loss ranging form 100 to 250 ml. The procedures were successful in 17 cases without residual stones after operation; intraoperative residual sand-like calculi were found in 1 case and removed by irrigation and drainage through nephrostomy tube; intraoperative missing calyceal calculi occurred in 1 case and were cleared by extracorporeal shock wave lithotripsy（ESWL）. A follow-up for 10 -60 months（ mean, 18 months）in 15 patients showed recurrence in 2 ones, and the stones were removed by ESWL. Conclusions Calicecotomy combined with trans-renal parenchyma pneumatic lithotripsy for complicated staghorn renal calculi has the advantages of less blood loss and definite efficacy.
出处
《中国微创外科杂志》
CSCD
2007年第10期940-941,共2页
Chinese Journal of Minimally Invasive Surgery
关键词
肾盏
肾结石
气压弹道碎石
Renal calyces
Renal calculi
Pneumatic lithotripsy
