摘要目的 探讨改良无萎缩性三步法肾实质切开取石术在复杂性鹿角形肾结石治疗中的应用效果.方法 回顾性分析2013年6月至2016年6月广州军区广州总医院泌尿外科收治的22例复杂性鹿角形肾结石的患者资料,男性13例,女性9例,年龄35 ～62岁,平均47岁.17例患者患侧腰部钝痛或隐痛,5例患者无临床症状于体检发现.15例患者结石位于左肾,7例结石位于右肾.行改良无萎缩性三步法肾实质切开取石术,记录手术时间、术中出血量和肾蒂阻断时间,评估术后并发症情况.比较手术前后血肌酐、血尿素氮、β2微球蛋白、患侧肾小球滤过率(GFR)和肾皮质厚度,复查CT评估结石清除率.手术前后检测指标的比较采用配对样本t检验.结果 22例患者均一次性取净结石,手术时间50～126 min,平均84 min,肾蒂阻断时间20～56 min,平均31 min,术中出血量150～360 ml,平均246 ml.患者一期愈合,无继发出血和尿瘘,术后3～7d拔除肾周引流管,平均住院时间7d.与术前相比,术后血肌酐[(172.7±21.3) μmol/L比(146.4±22.8) μmol/L,t=7.197,P=0.000]、血尿素氮[(9.2±1.8)mmol/L比(8.0±0.5)mmoL/L,t=3.798,P=0.001]和β2微球蛋白[(203.0±32.0)μg/L比(175.6±23.8) μg/L,t=5.009,P=0.000]均降低,患侧GFR升高[(28.6±4.0) ml/min比(31.8±3.3) ml/min,t=-3.521,P=0.002].患侧肾皮质厚度手术前后差异无统计学意义(t=-1.323,P=0.200).并发症包括12例术后疼痛、2例术后呕吐、3例发热、2例切口感染.术后随访6个月,患肾无残留结石.结论 改良无萎缩性三步法肾实质切开取石术取石彻底,对患肾功能影响小,并发症少,可用于治疗复杂性鹿角形肾结石.

abstractsObjective To investigate the effects of modified three-step procedure for anatrophic nephrolithotomy in the treatment of complex staghorn renal calculi.Methods A total of 22 patients with complex staghorn renal calculi between June 2013 and June 2016 at Department of Urology in Guangzhou General Hospital of Guangzhou Military Command were retrospective analyzed.There were 13 males and 9 females,ranging from 35 to 62 years old with mean age of 47 years.There were 17 patients with dull pain,and 5 patients who were found through physical examinations.Kidney calculi located in left kidney in 15 patients,right kidney in 7 patients.All patients were treated with modified three-step procedure for anatrophic nephrolithotomy.The operation time,blood loss,time of intraoperative renal ischemia,and postoperative complications were recorded.Serum creatinine (Scr),blood urea nitrogen (BUN),β2-microglobulin(β2-MG),diseased side glomerular filtration rate(GFR),and renal cortical thickness of the diseased kidney in preoperative and postoperative were compared.The clinical data were compared by paired sample t test between pre-operation and post-operation.Results The calculi were completely removed in 22 patients,the mean operation time was 84 minutes (50 to 126 minutes),the mean time of intraoperative renal ischemia was 31 minutes (20 to 56 minutes),the mean blood loss was 246 ml (150 to 360 ml).There were no secondary bleeding or urinary fistula happened,the perinephric drainage tub was removed in 3 to 7 days postoperative,the mean hospitalization time was 7 days.Compared with the preoperative,the Scr ((172.7±21.3) μmol/L vs.(146.4±22.8) μmol/L,t =7.197,P=0.000),BUN ((9.2± 1.8) mmol/Lvs.(8.0±0.5) mmol/L,t =3.798,P=0.001) and β2-MG ((203.0±32.0) μg/L vs.(175.6±23.8) μg/L,t=5.009,P=0.000) in postoperative decreased,the diseased side GFR increased ((28.6±4.0) mL/min 比 (31.8 ± 3.3) ml/min,t =-3.521,P =0.002).There were no significant difference of diseased renal cortical thickness between preoperative and postoperative(t =-1.323,P=0.200).There were 12 patients with postoperative pain,2 patients with vomiting,3 patients with fever,and 2 patients with wound infection.The follow-up time was 6 months,no residual stones in 22 patients.Conclusion The modified three-step procedure for anatrophic nephrolithotomy has high stone free rates with less effects on renal function and fewer complications,the method could be widely applied.