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目的探讨开放性手术治疗复杂性肾结石的手术方法。方法对34例复杂性肾结石患者采用静脉注射肌苷2.0g,原位低温下阻断肾动脉后行肾实质切开取石术。手术前后检查包括KUB、IVP、CT、B超、血BUN、Cr等,术后随访。结果34例手术均顺利完成,结石一次取净32例,2例残留结石经ESWL治愈。手术时间90～150min,平均110min;肾动脉阻断时间20～90min,平均40min;出血量100～450ml,平均150ml。术后并发出血1例,经保守治疗治愈,术后无并发症,随访6～24个月,患肾功能恢复良好。结论小切口原位低温下阻断肾动脉配合静脉注射肌苷行肾实质切开取石手术具有方法容易掌握、出血少、创伤小、肾功能损害小、手术安全等特点,是治疗复杂性肾结石安全、有效的方法之一,易于在无条件行微创手术的医院开展。
Objective To investigate the surgical treatment of complex renal calculi by open surgery. Methods 34 patients with complex renal calculus were treated with intravenous injection of inosine 2.0g. The renal artery was cut off at low temperature in situ followed by lithotomy. Preoperative and postoperative examination including KUB, IVP, CT, B ultrasound, blood BUN, Cr, etc., were followed up. Results All the 34 surgeries were successfully completed. Thirty-two cases of stone were removed and 2 cases of residual stones were cured by ESWL. Surgery time 90 ~ 150min, an average of 110min; renal artery blocking time 20 ~ 90min, an average of 40min; amount of bleeding 100 ~ 450ml, an average of 150ml. Postoperative bleeding in 1 case, after conservative treatment, postoperative complications, follow-up 6 to 24 months, suffering from renal function recovered well. Conclusion Small incision in situ cryogenic blockage of renal artery with intravenous inosine in renal parenchyma surgery is easy to grasp, less bleeding, less trauma, less renal damage, surgical safety and so on, is the treatment of complex renal stones One of the safe and effective methods is easy to carry out in unconditional minimally invasive surgery in hospitals.