鹿角形肾结石的治疗

目的　探讨经肾窦内肾盂切开和 /或气压弹道碎石治疗鹿角形肾结石的疗效。方法　对 6 8例、80个肾鹿角形结石采用在肾窦脂肪包膜与肾盂外膜之间的疏松结缔组织内充分分离达肾乳头 ,切开肾盂 ,并向肾窦内肾盂扩大的手术方法。对完全性鹿角形结石 ,结合气压弹道碎石 ,将结石分解成几块 ,再逐一取出。双侧肾结石采用一次分侧手术取石。结果　 34个部分鹿角形肾结石均完整取出 ,4 6个完全性鹿角形肾结石亦较顺利地取出。结论　①熟悉肾窦肾盂的解剖结构 ,术中充分分离肾窦内肾盂是取出鹿角形结石的关键。②对巨大的完全性鹿角形结石 ,采用气压弹道碎石是较好的方法。③双侧肾结石多有梗阻致肾功能受损 ,应双侧一次取石 ,有利于双肾功能恢复。分次手术应在 2周内进行     

改良气压弹道碎石杆联合肾盂切开治疗鹿角形肾结石

目的探讨改良气压弹道碎石杆联合肾盂切开在治疗鹿角形肾结石手术中的临床疗效及应用价值。方法对7例鹿角形肾结石患者采用肾盂切开,经肾盂切口介入改良后的气压弹道碎石杆碎石,将肾盂及各肾盏内的结石取出。结果全部病例手术顺利,3个月复查IVU,1例发现肾盏内残留约1cm小结石,其余患者未见结石残留,肾显影基本正常。结论在鹿角形肾结石开放性手术中,通过肾盂切口,利用改良气压弹道碎石杆治疗,具有损伤小、结石残留率低、恢复快、住院时间短及出血量少等优点,是一种安全高效的方法。     

肾窦内肾盂切开气压弹道碎石术治疗巨大鹿角形结石(附10例报告)

目的:提高手术治疗巨大鹿角形肾结石的疗效。方法:采用肾窦内肾盂切开气压弹道碎石术治疗巨大鹿角形肾结石患者10例。结果:10例患者均取石成功,平均手术时间108min,术中均无需输血。无手术后继发出血和感染等并发症,10例术后2～6个月内复查B超,1例肾内残余结石,直径均<0.7cm。结论:肾窦内肾盂切开气压弹道碎石术治疗巨大鹿角形肾结石效果满意,操作简便、安全、易掌握。     

肾盂切开联合气压弹道碎石术治疗肾复杂性结石

目的探讨气压弹道碎石术在肾盂切开治疗复杂性肾结石中的应用价值。方法采用肾盂切开联合气压弹道碎石术治疗肾复杂性结石9例。结果全组术中无大出血,无肾盂肾盏黏膜撕脱,无肾实质损伤,肾积水症状明显改善。1例患者肾盏内有小结石存留,外院行ESWL治疗后获愈。结论复杂性鹿角型和铸型结石治疗困难,肾盂切开联合气压弹道碎石术是一种安全有效的方法。     

肾实质切开取石与肾盂切开气压弹道碎石术治疗无萎缩肾巨大肾结石疗效比较

目的比较肾盂切开气压弹道碎石与肾实质切开取石术治疗无肾萎缩巨大肾结石的效果。方法160例无肾萎缩巨大肾结石患者,随机分为两组,采用肾盂切开气压弹道碎石术(A组,80例)与肾实质切开取石术(B组,80例)治疗。结果A组平均手术时间、平均出血量均较B组明显减少,术后肾功能恢复较好。结论肾盂切开气压弹道碎石术治疗无肾萎缩巨大肾结石,手术时间短,出血少,肾功能损害小,效果满意。     

选择性肾盏切开气压弹道碎石术治疗复杂性巨大鹿角形肾结石

目的探讨肾盏切开加气压弹道碎石术治疗复杂性巨大鹿角形肾结石的疗效。方法对8例巨大鹿角形肾结石患者行肾盏切开加气压弹道碎石术治疗。其中男6例,女2例,平均年龄45岁。病程4~12年,平均6年。2例为同侧肾结石手术后结石复发。结果8例患者均手术取石成功。无1例出现术中大出血而行肾切除。手术平均时间90min,平均出血100mL,均未输血。结石取净率75%(6/8),2例仍有残留小结石,1例行ESWL术,2月后排净。1例经肾造瘘瘘道局麻下进行气压弹道碎石,结石全部取净。2例有轻度氮质血症患者和5例术前IVU患肾显影延迟者,术后肾功能均得到明显改善。结论选择性肾盏切开气压弹道碎石术治疗复杂性巨大鹿角形肾结石具有术中出血少,创伤小,肾功能受损轻和术后并发症少等优点,是一种安全有效的结石治疗方法。     

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

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。     

肾窦扩大肾盂切开联合气压弹道碎石治疗肾巨大鹿角形结石(附218例报告)

目的　提高肾巨大鹿角形结石的手术疗效 ,探讨其手术治疗的最佳方式。　方法　采用肾窦扩大肾盂切开联合气压弹道碎石治疗肾巨大鹿角形结石 2 18例。　结果　所有患者均取石成功 ,平均手术时间 90min。术中无一例输血 ,术后无继发出血和感染等并发症发生。 2 0 0例术后 1～ 3月复查B超 ,10例肾内残余结石 ,直径均 <0 .8cm ,4例自行排出 ,6例经药物治疗后排净。　结论　肾窦扩大肾盂切开联合气压弹道碎石治疗肾巨大鹿角形结石疗效确切 ,操作简便、安全、易掌握。     

肾窦内肾盂切开电子弹道碎石取石术18例体会

2000年10月至2003年9月，我们对18例肾鹿角形结石患者采用肾窦内肾盂切开电子弹道碎石取石，效果满意，报告如下。     

肾盂切开气压弹道碎石术治疗肾复杂性巨大鹿角形结石

我们自1998～2003年采用肾盂切开气压弹道碎石术治疗肾复杂性巨大鹿角形结石患者6例，疗效满意，现报告如下。     

腹腔镜肾盂切开取石术联合切取法活检术在肾铸型结石合并肾盂癌诊治中的作用

本研究回顾性分析了2015年3月至2019年6月浙江大学医学院附属第二医院收治的3例肾铸型结石合并肾盂癌患者的病例资料,男2例,女1例。年龄52~81岁。既往均有腔镜碎石术史。3例术前检查发现肾盂或肾盂输尿管连接处可疑占位。3例均行腹腔镜肾盂切开取石术,术中切取占位组织活检,分别确诊为肾盂中-低分化鳞癌、浸润性尿路上皮...     

肾盂切开钬激光碎石取石术治疗孤立肾巨大鹿角形结石的疗效观察

目的：探讨和评价经肾盂切开钬激光碎石取石术治疗孤立肾巨大鹿角形结石的安全性和疗效。方法：回顾性分析接受经肾盂切开配合钬激光碎石取石术治疗的7例孤立肾巨大鹿角形结石患者的临床资料。结果：7例患者均手术顺利．术中出血量80～250ml,平均150ml、随访6～21个月,肾功能4例恢复正常．3例接近正常值范围．复查B超无结石残留。结论：该术式具有术中出血少、手术安全、对肾功能无明显影响、结石取净率高等优点,是一种处理孤立肾巨大鹿角形结石的较好方法。     

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.     

肾盂切开联合PL及纤维内镜下取石治疗肾鹿角状结石34例

目的 总结肾盂切开术中采用气压弹道碎石(PL)及纤维内镜下套石篮取石治疗肾鹿角状结石的临床疗效。方法 术中PL将结石碎成小块取出，残留于各小盏及黏附于肾盂粘膜的结石在纤维内镜下用套石篮取出。结果结石碎成小块易于取出，结合纤维内镜下套石篮取石，结石取净率达94．1％。结论 该方法安全、易掌握、疗效肯定、损伤小。     

肾窦内肾盂加肾后下段间切开治疗复杂鹿角形肾结石

目的　提高复杂鹿角形肾结石的手术疗效。方法　分析总结 36例复杂鹿角形肾结石患者行肾窦内肾盂加肾后下段间区切开取石术的临床资料。结果　 36例均取石成功 ,术后康复顺利。随访 32例 ,5例肾盏内残留小结石 (<0 .5cm)。结论　肾窦内肾盂加肾后下段间区切开取石术操作简便 ,对肾脏损伤小 ,效果满意。     

Combined percutaneous and extracorporeal shock wave lithotripsy for staghorn calculi: an alternative to anatrophic nephrolithotomy

Combinations of percutaneous and extracorporeal shock wave lithotripsy were performed on 46 patients with 52 staghorn calculi. Of the renal units 15 per cent had minute residual fragments but only 9.7 per cent with struvite had residual stones. The morbidity of this combined approach is less than that of anatrophic nephrolithotomy. We believe that the majority of staghorn calculi can be removed in this manner. Nephrostolithotomy should be the initial procedure in most instances. This less invasive approach is especially advantageous in patients at high risk for recurrence.     

自体肾移植结合腔道碎石技术治疗复杂性肾铸形结石的临床意义及疗效观察

目的探讨自体肾移植结合腔道碎石技术治疗复杂性肾铸形结石的临床意义。方法随访3例自体肾移植结合腔道碎石技术治疗复杂性肾铸形结石患者,通过复查3例患者术前、术后短期及长期肾功能变化来了解此术式对于患者肾功能的影响。结果3例患者术后短期及长期肾功能均良好。结论自体肾移植结合腔道碎石技术充分结合了腔道碎石技术与离体肾技术之优点,为复杂性肾铸形结石的治疗提供了一个更为微创、安全、有效的方法。     

Renal function study by 99mTc-DMSA renal scintigraphy in each treatment of staghorn calculi

From 1976 through 1984, 94 staghorn calculi of 86 patients were treated in this department. Kidney function was assessed by Tc-DMSA renal scintigraphy consisting of renal cortical imaging and DMSA renal uptake rate, in 84 kidneys preoperatively and 43 kidneys pre- and postoperatively. There was an increase in the postoperative DMSA renal uptake in the operated kidney, in 3 out of 14 kidneys in which pyelolithotomy was performed and in one out of 10 kidneys in which nephrolithotomy was done. It was still impossible to answer the question of which mode of operation should be chosen only from consideration of kidney function study. But it was suggested by the statistical investigation that nephrectomy seemed to be selected in the case of severely decreased renal function. It was reasonable that pyelolithotomy was the best method from the point of predicting the postoperative recovery of renal function. But in the near future, advances in endoscopical stone surgery and extracorporeal procedures, might reduce the damage of the renal function caused by conventional stone surgery.     

Percutaneous nephroscopic with holmium laser and ultrasound lithotripsy for complicated renal calculi

The aim of this work is to validate the clinical efficacy of the high-power holmium:YAG laser with percutaneous nephrolithotripsy (PCNL) in combination with ultrasound lithotripsy for complicated renal calculi. From November 2006 to December 2007, 60 patients with complicated renal calculi were treated with PCNL, where an F24 standard renal access tract was established by percutaneous renal puncture under the guidance of B-mode ultrasound, and stones were fragmented and cleared by high-power holmium laser in combination with ultrasound under an F20.8 nephroscope. Of the 60 patients with complicated renal calculi, 20 were complete staghorn calculi and 30 were partial staghorn calculi, of which six patients were accompanied with renal insufficiency; two were solitary calculi, and eight were caliceal diverticular calculi. Calculi were removed by one attempt in 49 patients and by two attempts in 11 patients; through one tract in 50 patients and through two and three tracts in ten patients. The stone-free rate was 81.7%. No injury to the pleura and abdominal organs occurred during the intraoperative puncture. No postoperative blood transfusion was needed in any patient, nor did fever and secondary hemorrhage occur. The mean operation duration was 98 min (range, 60–150 min), and the mean lithotripsy time was 45 min (range, 30–85 min). Additional postoperative extracorporeal shock wave lithotripsy (ESWL) was performed on six patients. High-power holmium laser PCNL in combination with ultrasound lithotripsy is safe, effective, and minimally invasive, with a high stone-free rate, especially for complicated renal calculi.