185例肾结石手术治疗临床分析.docVIP

185例肾结石手术治疗临床分析 　【摘要】 目的 探讨肾结石开放性手术治疗增多的原因并评估手术治疗的效果。方法 对185例肾结石患者手术前后的临床资料进行回顾性分析。结果 鹿角型结石83例,多发性结石122例；术前已体外碎石（ESWL）126例，22例无症状者首次治疗就选择了开放手术。结石残存率18.9%（35/185），配合ESWL后残石率在3.8%以下；伴肾功能不全12例，手术后肾功能不全治疗有效率为100%，治愈率83.3%（10/12）。结论 无效碎石病例的积累是肾结石开放手术增多的重要原因，手术方式和时机取决于患者的具体情况，恰当的术式能获得满意的疗效。无症状肾结石应引起高度重视。 【关键词】 肾结石 ； 外科手术 ；治疗 　　ＡＢＳＴＲＡＣＴ Ｏｂｊｅｃｔｉｖｅ To study the reason for the increase of open surgery for kidney calculi and to evaluate the effect of surgical treatment. Ｍｅｔｈｏｄｓ A retrospective analysis was made to the clinical data of 185 cases with kidney calculi before and after surgical treatment.Ｒｅｓｕｌｔｓ Staghom calculi were found in 83 cases, multiple calculi in 122 cases; 126 cases had received Extracorporeal Shock Wave Lithotripsy (ESWL) before the surgical treatment; 22 cases with no symptoms took open surgery as the first treatment; the residual stone rate was 18.9% (35/185) while the residual stone rate decreased to 3.8% after ESWL was added; in the 12 cases with kidney failure, the effective rate was 100% after surgery and the curative rate was 83.3% (10/12).Ｃｏｎｃｌｕｓｉｏｎ The increase of ineffective ESWL cases is the important reason for open surgery of kidney calculi, the operation style and time depend on the actual condition of the patients, and proper style may lead to satisfactory curative effect; more attention should be paid to the cases with no symptoms. 　　ＫＥＹＷＯＲＤＳ kidney calculi surgery treatment 　　随着体外冲击波碎石（ESWL）和经皮肾镜（PCN）等微创碎石技术的发展，肾结石开放性手术明显减少。1998年1月至2007年12月我院肾结石开放手术又呈增多趋势，为探讨开放手术增多的原因并分析疗效，我们对我院手术治疗肾结石的185例患者的资料进行了回顾性分析。现报告如下。 　　１ 资料与方法 　　１.１ 一般资料 　　本组185例中男性137例，女性48例，年龄23～58岁，平均41.5岁。结石直径1.8cm～5.6cm。鹿角型结石83例。单发63例，多发122例，其中双侧结石39例。合并肾功能不全（血肌酐208～427umol/L、尿素氮8.6～12.4mmol/L）12例，一侧肾无功能 11例， 8例伴有寒战高热（体温＞39℃），且WBC ＞9.86×109/L。曾行ESWL治疗126例，4次以上ESWL治疗85例。 　　1.2 手术方式 　　根据影像学检查提示的肾结石部位、形态、数量、肾功能、积水程度、肾盂肾盏结构形态及术中所见，行肾盂或肾窦内肾盂切开取石80例；肾盂切开取石加UPJ狭窄成行或局部炎性息肉切除34例；肾盂切开取石加肾折叠固定5例；肾窦内肾盂切开取石加肾实质切开取石47例（6例行肾窦后下部切开）；肾窦内肾盂切开取石加肾下极部分切除7例；患侧肾切除12