肾窦内肾盂切开取石38例临床研究

目的探讨肾窦内肾盂切开治疗复杂性鹿角状或铸状及多发性肾结石疗效。方法沿肾盂外间隙分离肾窦内肾盂，于肾中下1／3下盏上方无血管区用2-0合成可吸收缝线扣锁式全层缝合肾实质2排，其间切开肾实质，由肾上、下盏间作一弧形切口，取出较大的结石，直视下探查取出肾盏内小结石。结果30例结石一次性取净，占80％；8例有1—2粒小结石残留，术中仅2例输血200ml。随访6个月-6年，29例无肾积水，2例结石复发。结论肾窦内肾盂切开取石术具有出血少，不分离肾周脂肪，不阻断肾血流，肾功能受损轻，结石取净率高，无漏尿、易于掌握等优点。是肾内型肾盂内鹿角状或铸状及多发性结石的理想术式。     

原位低温阻断肾血管肾实质切开取石术

目的探讨原位低温阻断肾血管肾实质切开取石术治疗复杂性肾结石的效果。方法2000年3月～2005年1月采用原位低温阻断肾血管肾实质切开取石术治疗肾内型肾盂复杂性肾结石患者22例,术中快速静脉滴注肌苷2.0g,静滴20%甘露醇250ml。根据术前影像检查结果及术中所见选择肾切口径路:13例充填于各盏的鹿角状结石,行肾背侧Brodt线肾实质肾盏切开取石;5例肾下盏肾盂鹿角状结石,行肾盂肾实质联合切开取石;4例结石过多者,于肾皮质最薄处另作放射状切口取石。结果肾血管阻断时间平均45(30～60)min;手术时间平均110(90～180)min;平均失血量150(80～400)ml。结石一次取净21例,1例残余结石,术后2个月带双J管行ESWL碎石排出。术后1～2月复查肾功能,术前有肾功能损害的8例,血清Cr平均110.2μmol/L,血清BUN平均8.0mmol/L,均明显改善,其余患者肾功能无损害,无严重术后并发症。18例随访6个月～3年无一例复发。结论原位低温阻断肾血管肾实质切开取石术治疗复杂性肾结石安全有效、出血少、结石残留率低。     

常温下阻断肾蒂肾切开取石治疗复杂性铸型肾结石

目的 探讨常温下阻断肾蒂肾实质切开取石治疗复杂性铸型肾结石的临床疗效.方法 对20例复杂性铸型肾结石患者均采取常温下阻断肾蒂肾实质或+肾盂切开取石术.手术前、后检查包括腹部平片、静脉尿路造影、CT、B超、尿素氮、肌酐等项目并术后随访.结果 20例患者均顺利完成取石,一次性取净结石17例,结石残余残留率为15％.手术时间...     

肾窦内肾盂及肾后唇实质弧形切开取石术治疗复杂性鹿角形肾结石

目的 探讨肾窦内肾盂及肾后唇实质弧形切开取石术治疗复杂性鹿角形肾结石的疗效。方法 采用自行设计的肾窦内肾盂及肾后唇中下1／3肾实质弧形切开取石术治疗复杂性鹿角形肾结石86例97侧；右侧42例，左侧33例，双侧11例。合并输尿管结石17例，肾上盏、中盏和（或）多发性肾结石54例。肾功能不全25例，BUN12．3～76．0mmol／L，Scr 231～1721μmol／L。术中游离肾窦内肾盂后，2-0可吸收线在肾后唇中下1／3肾实质交界处作两排链扣式缝合肾实质全层，达肾下盏大组开口平面后继续弧形向上部作两排链扣式缝合，经肾中盏大组至其开口平面。沿此切口切开肾实质和肾盂及下中肾盏，边切边缝，用肾盂拉钩拉开肾实质即可取净肾盂、肾盏内结石。结果 86例97侧均一次取净结石。手术时间105～187min、平均129min。术中出血量120～460ml，平均220ml。43例输血．输血量120～200ml，平均140ml。术后1个月复查B超和KUB加IVU未几几残留结石，肾积水减轻，肾盏颈无狭窄。结论 肾窦内肾盂及肾后唇实质弧形切开取石术具有操作简单、安全，术野清晰，出血少，对肾损伤轻，一次性取净肾结石等优点，是治疗复杂性鹿角形肾结石较为理想的方法。     

盏颈切开术治疗肾内型肾盂复杂肾结石

目的　探讨盏颈切开取石术治疗肾内型肾盂复杂肾结石的疗效。　方法　对 5 2例肾内型肾盂复杂肾结石合并上盏和 (或 )下盏重度肾积水患者行经盏颈切开取石术。其中男 38例 ,女 14例 ,平均年龄 4 3岁。结石平均直径 4 .2cm。　结果　结石一次取净 4 4例 ,残余结石 8例 ,采用输尿管镜经肾造瘘瘘道行气压弹道碎石、取石 ,4例结石取净 ,4例仍有残余结石 ,行ESWL术。术中均未输血 ,术后无继发出血。 2 4例获随访 ,术后 6个月至 4年KUB加IVU复查 ,手术侧肾积水减少 ,无肾盂肾盏狭窄及结石复发。　结论　盏颈切开取石术具有术中出血少 ,肾集合系统破坏小 ,肾功能受损轻和术后并发症少等优点。适用于肾内型肾盂复杂性肾结石并发上盏和 (或 )下盏重度肾积水的治疗。     

指间阻断肾血流肾实质切开治疗复杂性肾结石

目的:探讨肾实质切开治疗复杂性肾结石的效果。方法:采用静脉滴注肌苷2.0,指间阻断肾血流肾实质切开治疗复杂性肾结石30例。十二肋缘下切口,游离肾脏,沿Brodel氏线纵行切开肾实质全层,直视下取石,冲洗。用4-0肠线或可吸收缝合线间断缝合肾盂肾盏粘膜,1-0肠线或可吸收缝合线缝合肾实质全层。结果:28例结石一次取净,2例小结石残留,经ESWL(体外冲击波碎石)治愈,1例为肾盂钙化灶。结论:手指间阻断肾血流肾实质切开适合于肾内型肾盂鹿角形(铸形)结石和复杂性肾结石手术治疗。     

复杂性肾结石不同开放手术疗效比较

目的评价不同的开放性手术治疗复杂性肾结石的疗效,以期降低结石残留率及保护肾功能. 方法回顾性分析采用不同术式治疗154例复杂性结石的临床资料,比较结石取净率、阻断肾血流时间及术后肾功能恢复情况. 结果肾窦内肾盂切开取石61例、肾盂 肾放射状切开取石18例、肾盂肾下段切开取石11例、肾盂肾实质(多处、小切口)切开取石42例、肾实质Brodel线剖开取石10例及肾部分切除术12例,阻断肾血流的时间平均分别为0、31、36、45、162及28 min.肾功能恢复情况:12例肾部分切除取石术肾功能恢复良好,肾窦内肾盂切开取石术、肾盂肾下段切开取石术、肾实质Brodel线剖开取石术各有1例未恢复,肾盂 肾放射状切开取石术有2例、肾盂肾实质多处、小切口切开取石术有6例未恢复. 结论对复杂性肾结石开放手术需根据结石的大小、肾盂形态、积水程度、所需时间及难度确定术式,同时选择静注肌苷或(/和)局部低温下进行.尽可能选用对肾功能损害小的肾窦内肾盂切开取石术或加作肾实质切口,减少肾实质Brodel线剖开取石术的应用.     

肾下盏入路单通道微创经皮肾穿刺取石术联合输尿管镜下取石术治疗肾结石

目的总结肾下盏入路单通道微创经皮肾穿刺取石术(MPCNL)联合输尿管镜下取石术(URL)治疗肾结石的经验。方法建立经皮肾下盏通道后行URL,在完成肾盂内碎石解除肾盂出口处梗阻后输尿管内放置双J管,然后改行单通道MPCNL。结果18例均一次肾造瘘成功。仅1例行URL时因输尿管镜未能触及结石失败,单行PCNL。手术平均时间107min。1次取石13例,2次取石5例。18例中4例有残留结石后均行体外冲击波碎石(ESWL),仅1例随访6个月仍有少量残留结石。术中、术后无严重并发症。结论肾下盏入路单通道MPCNL联合URL治疗肾结石具有效率高、结石取净率高、肾损伤小、并发症少等优点,可作为治疗以肾下盏及肾盂为主肾结石首选方法。     

复杂性肾结石153例手术治疗体会

目的 :探讨手术治疗肾结石的意义。方法 :对 15 3例复杂性肾结石采用手术治疗 ,其中肾盂 (含肾窦内肾盂 )切开取石 84例 ,肾盂肾下后唇切开取石 3 4例 ,肾实质切开取石 2 8例 ,肾下盏肾部分切除 2例 ,马蹄肾狭部离断肾实质联合切开取石 2例 ,重复肾合并肾结患肾切除 1例 ,肾结石并发脓肾肾切除 2例。结果 :术后有不同程度的出血 18例 ,9例并发尿路感染。结论 :复杂性肾结石治疗方法应根据情况而定 ,开放性手术尤其在基层医院仍占有很重要的地位。     

肾下极背侧肾盂肾盏联合切开取石术治疗复杂性肾结石

目的　探讨复杂性肾结石的手术方法。方法　对采用肾下极背侧肾盂肾盏联合切开取石的 85例复杂性肾结石患者的临床资料进行分析。结果　常温下不阻断肾血流 ,平均手术时间 135min ,术中平均出血 2 30mL。取出结石最大 6 .5cm× 4 .0cm×3.5cm ,最多 10 4枚。术后平均住院 14 .5d。术后 3月KUB +IVU复查 ,13例有结石残留 ,数量为 1～ 3枚 ,直径 <1cm。结论　本术式操作简单、出血少 ,显露清楚 ,取石干净 ,对肾功能影响小 ,是治疗复杂性肾结石的理想术式     

Laparoscopic pyeloplasty with concomitant pyelolithotomy

PURPOSE: We present our experience with laparoscopic pyeloplasty plus pyelolithotomy in patients in whom stones were not the cause of ureteropelvic junction obstruction. MATERIALS AND METHODS: A transperitoneal approach was used for laparoscopic pyeloplasty and pyelolithotomy in 19 patients (20 renal units). Before ureteropelvic junction repair stones were extracted through a small pyelotomy that was eventually incorporated into the final pyeloplasty incision. Stones in the renal pelvis were removed with rigid graspers under direct laparoscopic vision. A flexible cystoscope introduced through a port was used to extract stones in the calices. The renal pelvis was reconstructed based on the anatomy of the ureteropelvic junction. RESULTS: A median of 1 stone (range 1 to 28) was recovered. In 11, 8 and 1 patients the Anderson-Hynes dismembered pyeloplasty, Y-V plasty and the Heinecke Mickulicz procedure were performed, respectively. At 3 months 2 patients had residual calculi for a procedural stone-free rate of 90%. There was no evidence of obstruction in 18 of the 20 cases (90%), as confirmed by negative diuretic scan or radiological improvement of hydronephrosis. At a mean followup of 12 months (range 3 to 57) 2 additional patients had recurrent stones for an overall long-term stone-free rate of 80% (16 of 20). CONCLUSIONS: Laparoscopic pyelolithotomy is feasible when combined with pyeloplasty. Our results are comparable to those of stone removal during open pyeloplasty or percutaneous endopyelotomy. The advantages of open surgery appear to be maintained in this minimally invasive approach.     

B超引导下经皮肾镜钬激光治疗开放术后复杂性肾结石

目的 探讨B超引导经皮肾镜钬激光手术（PCNL）治疗开放手术后复杂性肾结石的手术技巧及临床效果.方法 回顾性分析2009年1月至2010年12月肾结石开放手术后复发性或残留复杂性结石35例患者临床资料,所有患者均曾行开放手术取石,其中曾行肾实质切开取石术20例,肾盂切开取石患者15例.多发性结石31例,铸型结石4例,单侧27例,双侧8例,合并尿路感染15例.结果 35例均成功建立通道并一期手术,其中单通道完成手术29例,双通道6例.经上组肾盏建立通道4例、中组肾盏建立通道16例,下组肾盏建立通道15例.平均手术时间117min,平均住院时间16d,一期手术清除结石29例,占82.9％.结论 B超引导经皮肾镜钬激光手术是治疗开放手术后肾结石微创、安全、有效方法.     

The residual calculi in conservative operation for renal calculi

One hundred and three kidneys with calculi in 100 patients, were treated by conservative renal surgery from Jan., 1980 to Dec., 1982. The operative technique consisted of pyelolithotomy, extended pyelolithotomy, dismembered pyelolithotomy, nephrolithotomy (bivalve or anatrophic nephrolithotomy) partial nephrectomy and pyelo-nephrolithotomy. Intraoperative X-ray and coagulum lithotomy were employed when pyelolithotomy was performed. Thirty-five residual calculi in 20 kidneys were observed on postoperative X-ray film. The rate of residual calculi was 19.4%. Factors causing residual calculi, were analysed on these 103 kidneys. The factors were as follows; the shape of calculi: staghorn calculus with multiple small calculi, the shape of the renal collecting system: narrow pelvis with narrow caliceal neck and dilatated calices, and the operative technique: nephrolithotomy. These results suggested that it would be necessary to minimize residual calculi when performing nephrolithotomy.     

肾窦内肾盂加肾实质联合切口治疗复杂性肾结石

目的 探讨治疗复杂性肾结石的手术方法。方法 对采用肾窦内肾盂加肾实质联合切开术治疗的36例复杂性肾结石患者的临床资料进行回顾性分析。结果 肾结石全部取净,术中不需要阻断肾蒂及局部低温处理、平均水中出血300ml,平均手术时间120min。术后B超或KUB检查,4例患者肾内有残余结石。结论 本手术方式符合肾动脉及其分支的解剖,肾损伤最小,手术步骤简单,易掌握,术中出血少,易取净结石,是较为合理的手术方法。     

Multimodal management of urolithiasis in renal transplantation

OBJECTIVE: To report the largest single series of renal transplant patients (adults and children) with urolithiasis, assess the risk factors associated with urolithiasis in renal transplant recipients, and report the outcome of the multimodal management by endourological and open procedures. PATIENTS AND METHODS: The records of all patients undergoing renal transplantation between 1977 and 2003 were reviewed. In all, 2085 patients had a renal transplant at our centre and 21 (17 adults and four children) developed urinary tract calculi. Their mode of presentation, investigations, treatments, complications and outcomes were recorded. Investigations included one or more of the following; ultrasonography (US), plain abdominal X-ray, intravenous urography, nephrostogram and computed tomography. Management of these calculi involved extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy and in situ lithotripsy, percutaneous nephrolithotomy (PCNL), open pyelolithotomy and open cystolitholapaxy. RESULTS: Thirteen patients had renal calculi, seven had ureteric calculi and one had bladder calculi. The incidence of urolithiasis was 21/2085 (1.01%) in the series. Urolithiasis was incidentally discovered on routine US in six patients, six presented with oliguria or anuria, including one with acute renal failure, four with a painful graft, three with haematuria, one with sepsis secondary to obstruction and infection and in one, urolithiasis was found after failure to remove a stent. Ten patients (63%) had an identifiable metabolic cause for urolithiasis, two by obstruction, two stent-related, one secondary to infection and in six no cause was identifiable. Thirteen required more than one treatment method; 13 (69%) were treated by ESWL, eight of whom required multiple sessions; eight required ureteric stent insertion before a second procedure and four required a nephrostomy tube to relieve obstruction. Two patients had flexible ureteroscopy and stone extraction, three had a PCNL and one had open cystolithotomy. PCNL failed in one patient who subsequently had successful open pyelolithotomy. All patients were rendered stone-free when different treatments were combined. CONCLUSIONS: The incidence of urolithiasis in renal transplant patients is low. There is a high incidence of metabolic causes and therefore renal transplant patients with urolithiasis should undergo comprehensive metabolic screening. Management of these patients requires a multidisciplinary approach by renal physicians, transplant surgeons and urologists.     

Comparative results of shockwave lithotripsy for renal calculi in upper, middle, and lower calices

BACKGROUND AND PURPOSE: To assess the results of shockwave lithotripsy (SWL) for renal calculi in upper, middle, and lower calices according to the stone burden. PATIENT AND METHODS: A series of 52 female and 66 male patients with a mean age of 47.8 years and isolated single caliceal stones who underwent SWL monotherapy were enrolled. Stone burden, stone location, number of sessions/shockwaves, and auxiliary procedures were noted for each patient. Stones were located in the upper, middle, and lower calices of 35, 43, and 40, patients respectively, with mean stone burdens of 81.4 mm2, 75.2 mm2, and 96.3 mm2, respectively. Patients were evaluated with intravenous urography, plain film, or ultrasonography. Success was determined 3 months after the last session. Re-treatment rates were calculated. The effect of anatomic factors on the success of treatment for lower-caliceal stones also was determined. RESULTS: The mean stone burden, median number of treatment sessions, and mean number of shockwaves were 84.2 mm2, 2, and 4344, respectively. The auxiliary procedure rate was 16.1%, and the re-treatment rate was 71.2%. Failure was noted in 26 patients (22%). The stone-free rates for stones in the upper, middle, and lower calices were 82.8%, 83.4%, and 67.5%, respectively (P = 0.14). The stone-free rates for stones <100 mm2 and 100 to 200 mm2 were 91.2% and 65.5%, respectively (P = 0.001). The efficiency quotient was 49.8, 44.8, and 32.5 for upper-, middle-, and lower-caliceal stones, respectively. Infundibular length (P = 0.006) and infundibular width (P + 0.036) were significant in determining the stone-free rate after treatment of lower-caliceal stones. CONCLUSIONS: We recommend SWL as the first choice for treatment of stones <200 mm2 in the upper and middle calices. Extracorporeal lithotripsy is one of the options for lower-caliceal stones <200 mm2 but has high re-treatment and auxiliary-procedure rates in these cases.     

微创经皮肾镜碎石取石术治疗鹿角形肾结石52例分析

目的:探讨微创经皮肾镜碎石取石术(mPCNL)治疗鹿角形肾结石的疗效和安全性。方法:应用PCNL治疗52例鹿角形肾结石,采用实时彩色多普勒超声引导穿刺、扩张建立F16微通道,钬激光粉碎结石。统计结石清除率以及手术并发症等。结果:52例均一期建立通道。一次治疗结石清除率71.2%,总清除率84.7%,术后2例出现发热,未发生脏器损伤和感染性休克病例。结论:mPCNL治疗鹿角形肾结石效率高、出血量少,是治疗鹿角形肾结石的安全、有效方法。     

一期输尿管软镜钬激光碎石术治疗双侧肾结石2O例报告

目的：探讨一期组合式输尿管软镜钬激光碎石术治疗双侧’肾结石的临床疗效及安全性。方法：2010年1月~2012年1月采用德国铂立组合式输尿管软镜联合钬激光一期治疗双肾结石患者20例,结石大小0．7～2．0cm,平均1．3cm。含有大于1cm肾结石12例。20例均为双肾结石,含结石68枚,位于肾上盏13枚,中盏17枚,下盏18枚,肾盂20枚。结果：本组20例双肾结石均顺利完成一期双侧手术。一次手术结石清除率为80．0％（32／40）。本组总结石寻及率95．6％（65／68）。其中上、中盏及肾盂结石寻及率100％,单次碎石成功率92．0％（46／50）;下盏结石寻及率83．3％（15／18）,单次碎石成功率72．2％（13／18）。一期双侧手术总时间70～120min,平均90min。术中无输尿管穿孔等严重并发症发生。住院时间3～7d,平均4．2d。术后随访3～6个月,KUB或CT未见结石复发。结论：双肾结石采用输尿管软镜钬激光碎石术治疗安全、有效。尤其对于肾结石体积较小患者,可实施一期治疗双肾结石,以缩短治疗周期,减少费用。     

小功率钬激光经皮肾输尿管镜碎石术联合冲击波碎石治疗复杂性肾结石

目的探讨小功率钬激光经皮。肾输尿管镜碎石术联合体外冲击波碎石治疗复杂性肾结石的有效性和安全性。方法应用小功率（20W：0．6～0．8J×10-20Hz）钬激光经皮肾穿刺微造瘘输尿管镜配合体外冲击波治疗复杂性肾结石31例,分析小功率钬激光碎石术联合体外冲击波碎石的碎石时间、结石排净率、并发症等。结果平均碎石时间为85min（60—120min）,总的取净率为87．09％（27／31）;术中出血量估计平均为80ml．术后3例患者出现高热,无其他严重并发症。结论小功率钬激光经皮肾输尿管镜碎石术联合体外冲击波碎石治疗复杂性肾结石是一种安全、有效的方法。