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目的探讨治疗复杂性肾结石的手术方法,以减少术中出血,保护肾功能,降低肾切除率。方法37例40个肾脏采用原位低温肾动静脉同时阻断进行肾实质切开取石,术中同时静脉注射肌苷2.0 g。结果肾动静脉血流阻断时间为15～60 min,平均35 min。出血量为100～350 ml。肾实质切口4～8 cm(其中8例在肾实质分别作2～4处切口)。对发性结石19例分别取出结石10～80颗(最大8.8cm×5.2 cm×5.0 cm,最小如砂粒状。手术时间80～160 min,平均110 min,术中出血量少,术后血尿时间2～6 d,平均3 d。12例获得8～24个月随访,均行IVU复查,患肾功能恢复正常,无肾盂狭窄情况。结论原位低温肾动静脉阻断加静脉注射肌苷进行肾实质切开取石术,治疗复杂性肾结石具有取石彻底、快捷、出血少诸特点,并能较好地保护肾功能。
Objective To explore the surgical treatment of complex renal calculus in order to reduce intraoperative bleeding, protect renal function and reduce the rate of nephrectomy. Methods 37 cases of 40 kidneys were treated with in-situ hypothermic renal artery and vein occlusion for renal parenchymal incision and stone removal. At the same time, inosine 2.0 g was intravenously injected intraoperatively. Results Renal and venous blood flow blocking time was 15 ~ 60 min, an average of 35 min. Bleeding volume of 100 ~ 350 ml. Renal parenchyma incision 4 ~ 8 cm (8 cases in the renal parenchyma were made for 2 ~ 4 incision). Of the 19 patients with stone-induced calculi, 10 to 80 calculus (maximally 8.8 cm × 5.2 cm × 5.0 cm, respectively) were obtained from 19 patients with stone calculi, operation time was 80 to 160 min, average time was 110 min, blood loss was less, postoperative hematuria time 2 ~ 6 d, an average of 3 d.12 cases were 8 to 24 months follow-up were performed IVU review, the recovery of renal function, no renal pelvis stenosis.Conclusion In situ hypothermic renal artery and vein occlusion plus intravenous injection of inosine Renal parenchymal lithotomy, the treatment of complex renal stone with a thorough stone, quick, less bleeding and other characteristics, and can better protect renal function.