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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未见残留结石,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。
Objective To investigate the curative effect of intrarenal renal pelvis and renal posterior lip real arc incision and lithotomy in the treatment of complicated antler kidney stones. Methods A total of 97 cases of complex deer horn-shaped nephrolithiasis were treated with self-designed renal pelvis and renal pelvis in the lower third of the kidney. 11 cases. In 17 cases with ureteral stones, renal upper calyx, middle caliber and (or) 54 cases of multiple kidney stones. Renal insufficiency in 25 cases, BUN12.3 ~ 76.0mmol / L, Scr 231 ~ 1721μmol / L. Intraoperative free renal sinus after the renal pelvis, 2-0 absorbable line in the kidney posterior lip in the lower 1/3 of the renal parenchyma junction for two rows of chain-link suture the full-thickness renal parenchyma, up to the large group of renal openings after the plane continued Arc to the upper part of the two rows of chain-stitched suture, large group by the kidney to its open plane. Along the incision cut the renal parenchyma and the lower pelvis and renal calyx, while cutting edges, pulling the renal pelvis with a pull hook renal pyramid can be taken net. Kidney, calyx calculus. Results 86 cases of 97 sides were taken net stones. Surgery time 105 ~ 187min, an average of 129min. Intraoperative bleeding 120 ~ 460ml, an average of 220ml. 43 cases of blood transfusion, blood transfusion 120 ~ 200ml, an average of 140ml. One month after operation, no residual stones were found in B-ultrasonography and KUB plus IVU, hydronephrosis was relieved, and nephroses neck was not stenosed. Conclusion The renal pelvis and renal posterior lip real arc incision and lithotomy has the advantages of simple operation, safety, clear operative field, less bleeding, less damage to the kidney and nephrolithiasis in one time. It is a good way to treat the complex antler kidney Stone is the ideal method.