CAJ | 학술논문

目的探讨原位无萎缩性肾实质切开取石术治疗巨大肾鹿角形结石的方法和疗效.方法 52例患者,术前评估包括尿常规、尿细菌培养、肾功能、彩色多普勒超声、CT、立位腹部X线平片(KUB)和IVU检查.术中腰部第11肋间切口入路,充分游离肾脏,原位低温阻断肾蒂后,于相对无血管区大切口切开肾实质、肾盏、肾盂,取出结石,重建集合系统,缝合肾实质,恢复肾脏血供.术中采用肾功能保护措施.术后随访包括尿常规、肾功能、彩色多普勒超声、KUB、IVU和核素肾扫描.结果手术时间(117±45)min.肾缺血时间(29±15)min.术中输血5例,平均输血230 ml.结石残留4例,结石清除率92.3%.术后均无近期并发症,随访肾功能均正常.结论原位无萎缩性肾实质切开取石术是治疗巨大肾鹿角形结石安全有效的方法,术后并发症少,结石一次性取出、清除率高,术后复发率低.经过系列肾功能保护处理,对肾功能损害小,部分病例避免了肾切除.
목적 탐토원위무위축성신실질절개취석술치료거대신록각형결석적방법화료효.방법 52례환자,술전평고포괄뇨상규、뇨세균배양、신공능、채색다보륵초성、CT、립위복부X선평편(KUB)화IVU검사.술중요부제11륵간절구입로,충분유리신장,원위저온조단신체후,우상대무혈관구대절구절개신실질、신잔、신우,취출결석,중건집합계통,봉합신실질,회복신장혈공.술중채용신공능보호조시.술후수방포괄뇨상규、신공능、채색다보륵초성、KUB、IVU화핵소신소묘.결과 수술시간(117±45)min.신결혈시간(29±15)min.술중수혈5례,평균수혈230 ml.결석잔류4례,결석청제솔92.3%.술후균무근기병발증,수방신공능균정상.결론 원위무위축성신실질절개취석술시치료거대신록각형결석안전유효적방법,술후병발증소,결석일차성취출、청제솔고,술후복발솔저.경과계렬신공능보호처리,대신공능손해소,부분병례피면료신절제.
Objective To discuss the method and effect of large renal staghorn calculi by anatrophic nephrolithotomy (AN).Methods Fifty-two patients with large renal staghom calculi underwent AN.Bilateral renal calculi disease was present in 3 patients,so that a number of 55 procedures were operated.Preoperative evaluation included urinalysis,urine culture,renal function,and ultragound,CT,KUB and IVU.A flank incision was between the 11th and 12th ribs and the kidney was freed.After interrupted renal pedicle in situ hypothermia,the renal parenchyma incision was made along the avascular plane which is outside in the back of the kidney.The collecting system was opened.The calculi were removed.The collecting system was reconstructed.The renal parenchyma was closed and the renal circulation was reestablished.The protected management of renal function was made intraoperative.Postoperative follow-up consisted of urinalysis,renal function,ultrasound,KUB,IVU and ECT.Results The operative time was (117±45) minutes.The renal ischemia time WaS (29±15)minutes.Five cases underwent blood transfusion.Mean amount of blood transfusion was 230 ml.Four cases had remained calculi.The stone-free rate was 92.3%.No recent complication occurred after operation.Postoperative follow-up indicated that renal function was normal.Conclusions AN is the most appropriate method for patients with large renal staghorn calculi because of the highest stone-free rate,the lowest stone-recurred rate and a safe and effective operative procedure with less complication.Renal function damages just little through a series of protected management.Nephrectomy is avoided to part of patients.