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1、复杂性肾结石肾实质切开取石术不同术式探讨【摘要】目的通过不同术式的比较以提高复杂性肾结石的手术疗效，降低结石的残留率及术后肾功能的恢复。方法回顾，总结，分析35例复杂性肾结石不同术式手术治疗的临床资料。结果低温阻断肾动脉肾实质切开取石术组18例动脉阻断时间25～65min，出血量80～400ml，手术时间90～170min。间断性不完全性肾蒂阻断行肾实质切开取石组17例手术病人,12例手术病人出血少于200ml均未输血,有2例患者术中出血稍多输血400ml,手术取石时间(从上肾蒂钳到肾实质缝合完毕后取肾蒂钳)15～25min,平均17.5min。手术取石时间短,平均13.2m
2、in,术后患肾功能均正常。结论对肾窦内肾盂铸型肾结石开放手术治疗需要根据结石的大小、形态、手术所需的时间及难易程度确定术式。低温阻断肾动脉肾实质切开取石术具有出血少、显露充分、术野清晰、结石取净率高等优点。间断不完全性肾蒂阻断下行肾实质切开取石术具有简单、快捷、肾功能损伤小、恢复快等优点。【关键词】肾结石;外科手术Theexplorationofvariousnephrotomyofremovalthestonesfortheplexnephrolithiasis【Abstract】ObjectiveTothepurposeofpromotethesurgicaloperat
3、ingeffectaboutplexkidneystonefromtheparisonofdifferentsurgicaldecreasetheremainarateofkidneystoneandtherecoverthekidneyfunction.MethodsReviedifferentsurgicaloperationmethod.ResultsThereare18examplesatoperationtocutopenthekidneyandtakestoneintheenvironmenttostopkidneyarterytakes25～65min.Theb
4、leedingquantityis80～400ml,itis90～170mintooperation.Thereare17examplestocutopenthekidneyparenchymaandtakestoneinaenvironmenttointerruptedandimperfectlystopthekidneypedicel,thereare12patientstobleedingof200ml，notyetbloodtransfusion.Thereare2patientsofbloodtransfusion400ml,becauseofbleedingmuc
5、h,thetimeoftakingthestone(fromtakethekidneypedicleforcepstogetitandseais15～25min)is17.5min,thetimeoftakingstonefromkidneysubstanceisshort,theaverageis13.2min，therenalfunctionofthetroublekidneyisnormalofoperation.ConclusionItistodecidetheoperationthatthekidneystoneandpelvistypeonthebasisofth
6、esideandshapeofkidneystoneandtherequirementofoperationtime,thequalityofrateakidneystonefromcutopenkidneyinaloperatureisfullrevealandtheoperationfieldisclear,therateoftakethestoneishigh,thereisaqualityofsimpleshortcutandshortoffunctiondamageandrecoverquicklyintheoperationmethodoftakethekidne
7、ystonefromcutopenthekidneysubstanceinaenvironmentofstoptherenalpedicleinterruption.【Key。间断性不完全性肾蒂阻断行肾实质切开取石组17例也均为肾内型肾盂肾结石患者，其中男10例,女7例,年龄26～72岁,平均46岁,左肾结石9例,右肾结石8例，有1例为体外冲击波碎石治疗失败而改为开放性手术的。以上病例术前均经B超、KUB、IVP、CT及逆行肾盂造影等影像学检查而明确诊断。1.2手术方法低温阻断肾动脉肾实质切开取石术组取
