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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 15 4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 6 1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 4 2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、4 5、16 2及 2 8min。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。
Objective To evaluate the curative effect of different open surgeries on complex nephrolithiasis with a view to reducing the residual rate of stone and protecting renal function. Methods The clinical data of 154 cases complicated with calculi treated by different surgical procedures were retrospectively analyzed. The rate of stone removal, the time of blocking renal blood flow and the recovery of postoperative renal function were compared. Results Sixteen cases of pyelolithotomy were performed in the renal sinuses, 18 cases were obtained by radial pelvic pyeloplasty in renal pelvis and renal pelvis, 11 cases were obtained by incision and extraction of pelvis and renal pelvis, 42 cases of renal pelvis and renal parenchyma (multiple incision) In the Brodel line, 10 patients underwent partial nephrectomy and 12 patients underwent partial nephrectomy. The average time for blocking renal blood flow was 0, 31, 36, 45, 16 2 and 28 min, respectively. Renal function recovery: 12 cases of partial nephrectomy and lithotomy had a good recovery of renal function, pyelolithotomy in the renal sinus, lithotomy of the lower pelvis and lower renal pelvis, Radical renal lithotomy in 2 cases, multiple renal pelvis and plexus, small incision and lithotomy 6 cases did not recover. Conclusions Open surgery for complex nephrolithiasis should be based on the size of the stone, the renal pelvis morphology, degree of hydronephrosis, the time and difficulty of determining the surgical procedure, while selecting intravenous inosine or (/ and) local low temperature. As far as possible the selection of small renal damage renal celiotomy pyelolithotomy or plus renal parenchyma incision, reducing the renal parenchymal Brodel line dissection lithotomy applications.