Yang C L, Wang W, Zhou W E, Xue Y P, Wang B Q, Nie H B, Hu W L
Department of Urology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China.
Zhonghua Wai Ke Za Zhi. 2017 Oct 1;55(10):746-750. doi: 10.3760/cma.j.issn.0529-5815.2017.10.006.
To investigate the effects of modified three-step procedure for anatrophic nephrolithotomy in the treatment of complex staghorn renal calculi. 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), β(2)-microglobulin(β(2)-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 test between pre-operation and post-operation. 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 . (146.4±22.8)μmol/L, =7.197, =0.000), BUN ((9.2±1.8)mmol/L . (8.0±0.5)mmol/L, =3.798, =0.001) and β(2)-MG ((203.0±32.0)μg/L . (175.6±23.8)μg/L, =5.009, =0.000) in postoperative decreased, the diseased side GFR increased ((28.6±4.0) ml/min(31.8±3.3) ml/min, =-3.521, =0.002). There were no significant difference of diseased renal cortical thickness between preoperative and postoperative(=-1.323, =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. 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.
探讨改良三步法无萎缩性肾切开取石术治疗复杂性鹿角形肾结石的效果。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患者的临床资料。其中男13例，女9例，年龄35～62岁，平均47岁。17例因腰部钝痛就诊，5例经体检发现。结石位于左肾15例，右肾7例。所有患者均采用改良三步法无萎缩性肾切开取石术治疗。记录手术时间、出血量、术中肾脏缺血时间及术后并发症。比较术前、术后血清肌酐（Scr）、血尿素氮（BUN）、β2微球蛋白（β2-MG）、患侧肾小球滤过率（GFR）及患肾皮质厚度。采用配对样本t检验比较手术前后临床资料。22例患者结石均完全清除，平均手术时间84分钟（50～126分钟），平均术中肾脏缺血时间31分钟（20～56分钟），平均出血量246毫升（150～360毫升）。术后无继发性出血及尿瘘发生，术后3～7天拔除肾周引流管，平均住院时间7天。与术前比较，术后Scr[（172.7±21.3）μmol/L.（146.4±22.8）μmol/L，t=7.197，P=0.000]、BUN[（9.2±1.8）mmol/L.（8.0±0.5）mmol/L，t=3.798，P=0.001]及β2-MG[（203.0±32.0）μg/L.（175.6±23.8）μg/L，t=5.009，P=0.000]降低，患侧GFR升高[（28.6±4.0）ml/min（31.8±3.3）ml/min，t=-3.521，P=0.002]。术前、术后患肾皮质厚度比较差异无统计学意义（t=-1.323，P=0.200）。术后疼痛12例，呕吐2例，发热3例，伤口感染2例。随访6个月，22例均无残余结石。改良三步法无萎缩性肾切开取石术结石清除率高，对肾功能影响小，并发症少，可广泛应用。
