CAJ | 학술논문

目的：探讨开放性手术低温条件下采用肾动脉阻断治疗复杂肾结石患者的方法以及临床疗效。方法：对32例复杂性肾结石患者采用静脉注射肌苷2．0 g，原位低温下阻断肾动脉后行肾实质切开取石术。术前经CT、KUB、IVP等检查诊断鹿角形结石或（和）多发结石。平均年龄48（19～65）岁。左肾24例，右肾8例。病史6个月～20年。结石最大直径2．5～7．0 cm，平均为3．5 cm。，术后随访。结果：本组均采用原位低温肾动脉阻断肾实质切开取石术。血流阻断时间15～40分钟，平均25分钟，术中出血量80～300 ml，平均180ml，肾实质切口大小3～5 cm，平均3．5cm，手术操作时间90～150分钟，平均110分钟。术中无大出血及血管损伤。术后并发大出血1例，再次手术缝合止血顺利出院，3例术后肉眼血尿2～3个月，经保守治疗后治愈，无并发症。结论：小切口原位低温下阻断肾动脉配合静脉注射肌苷行肾实质切开取石手术具有方法容易掌握、出血少、创伤小、肾功能损害小、手术安全等特点，是治疗复杂性肾结石安全、有效的方法之一，易于在无条件行微创手术的医院开展。
목적：탐토개방성수술저온조건하채용신동맥조단치료복잡신결석환자적방법이급림상료효。방법：대32례복잡성신결석환자채용정맥주사기감2．0 g，원위저온하조단신동맥후행신실질절개취석술。술전경CT、KUB、IVP등검사진단록각형결석혹（화）다발결석。평균년령48（19～65）세。좌신24례，우신8례。병사6개월～20년。결석최대직경2．5～7．0 cm，평균위3．5 cm。，술후수방。결과：본조균채용원위저온신동맥조단신실질절개취석술。혈류조단시간15～40분종，평균25분종，술중출혈량80～300 ml，평균180ml，신실질절구대소3～5 cm，평균3．5cm，수술조작시간90～150분종，평균110분종。술중무대출혈급혈관손상。술후병발대출혈1례，재차수술봉합지혈순리출원，3례술후육안혈뇨2～3개월，경보수치료후치유，무병발증。결론：소절구원위저온하조단신동맥배합정맥주사기감행신실질절개취석수술구유방법용역장악、출혈소、창상소、신공능손해소、수술안전등특점，시치료복잡성신결석안전、유효적방법지일，역우재무조건행미창수술적의원개전。
Objective:Explore the open surgery by renal artery block under the condition of low temperature treatment of complex method and clinical efficacy in patients with kidney stones .Methods:32 cases of patients with renal stones complexity by intravenous in-jection of inosine 2.0 g, block the renal artery in situ low temperature renal parenchyma incision after nephrolithotomy .Preoperative CT, the KUB, IVP, such as inspection diagnosis antlers or (and) multiple stones.The average age is 48 (19-65).The left kidney was 24 cases, 8 cases of right kidney .History was 6 months to 20 years.The stone diameter is from 2.5 to 7.0 cm, with an average of 3.5 cm. Results:All use of in situ cryogenic renal artery block the renal parenchyma incision nephrolithotomy .Blocking blood flow to the time 15 to 40 min, an average of 25 min, intraoperative blood loss , 80-300 ml, 180 ml, average renal parenchyma incision size 3-5 cm, 3.5 cm, operation time, 90-90 min, an average of 110 min.Intraoperative bleeding and blood vessel damage .Concurrent Hemorrhage 1 case, postoperative surgical suture bleeding again smoothly discharged from the hospital , 3 cases of postoperative naked eye hematuria 2-3 month, cured with conservative treatment , no complications .Conclusion:Small incision in situ under low temperature block the renal ar-tery with intravenous injection of inosine line incision of renal parenchyma lithotomy surgery method is easy to grasp , less bleeding , small trauma, small renal impairment, operation safety, etc, is one of the complexity of kidney stones in safe and effective treatment method , easy in unconditional hospital development of minimally invasive surgery .