复杂性肾结石取石术后肾盏肾盂闭锁的防治探讨

目的：探讨复杂性肾结石取石术后发生肾盏或肾盏闭锁的原因和防治措施。方法：回顾性地分析诊治的7命名中层得之影像学、取石的手术方法及肾引流方式等资料，以评价取石术后肾盏肾盂闭锁可能发生的原因。再手术时采用输尿管与肾下盏吻合3例，回肠代输尿管1例，扩张肾盏之间打通的旁路手术和肾盏狭窄部扩大成形术1例，肾切除2例。结果：所有患者手术后恢复良好，5例经上述手术后重建了患侧上尿跃通畅引流，治愈出院。结论：凡肾盂狭小、肾盏漏斗部狭小而肾盏显著扩张者，在取石过程中盲目钳夹造成肾盏肾盂粘膜广泛创伤而又未安置双J管内引流仅作肾造瘘者，有可能发生此类并发症。肾下盏与输尿管吻合术是治疗肾盂闭锁的较好方法，某一主盏的闭锁可行肾盏与肾盏沟通的旁路手术以重建上尿路通畅引流。

The prevention and cure of calyx and pelvis atresia after nephrolithotomy for complex renal calculi

Purpose:To study the cause,prevention and cure of calyx and pelvis atresia after Nephrolithotomy for complex renal calculi. Method:Clinical data of 7 cases were retrospectively reviewed. Result:Ureterocalicostomy for 3 cases,Ileal replacement of the ureter for 1 case, Bypass operation connecting adjacent dilated calyx for 1 case, nephrectomy for 2 cases.and 5 cases have normal drainage after opteration.Conclusion:Calyx and pelvis atresia are possible for patients that there are narrow pelvis or calyx infundibulum with obvious dilated calyx, if mucosae of pelvis and calyx were injuried widely without Double-J ureteral stent. Ureterocalicostomy may be best surgical method for pelvis atresia.