Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil.
Universidade Federal do Rio Grande do Sul - UFRS, Porto Alegre, RS, Brasil.
Int Braz J Urol. 2020 May-Jun;46(3):489-490. doi: 10.1590/S1677-5538.IBJU.2019.0148.
: Minimally invasive treatments such as extracorporeal shock wave lithotripsy and percutaneous nephrolithotripsy are standard procedures for the management of renal stones (1). However, renal position and rotation defects may significantly interfere in the results of these treatments (2). Open surgery has always been an option for these cases, but with the advancement of laparoscopy in the last decades, laparoscopic pielolitotomy has become a good alternative for approaching kidney stones in abnormal renal rotation and position (3).
: A 42-year-old male patient with a 2.2cm stone in the left pelvic kidney was submitted to laparoscopic pielolitotomy after extracorporeal schok wave lithotripsy failure and difficulty in access for percutaneous nephrolithotripsy. We did not have access to flexible ureteroscopy for this case.
: The surgical time was 150 minutes. An antegrade JJ stent was inserted and renal pelvic suture was performed with vicryl 4-0. There was no need for opioids and patient was discharged on the first postoperative day. The JJ stent was removed after 1 month, with complete resolution of the clinical symptoms.
: Laparoscopic pielolitotomy is an excellent treatment alternative for patients with large stones in pelvic kidney.
体外冲击波碎石术和经皮肾镜碎石术等微创治疗是治疗肾结石的标准方法 (1)。然而，肾脏位置和旋转缺陷可能会严重影响这些治疗的效果 (2)。对于这些病例，开放性手术一直是一种选择，但在过去几十年腹腔镜技术的进步下，腹腔镜肾切开取石术已成为治疗异常肾旋转和位置肾结石的一种良好选择 (3)。
一名 42 岁男性患者左侧肾盂下极有一颗 2.2cm 的结石，在体外冲击波碎石术失败且经皮肾镜碎石术难以进入后，接受了腹腔镜肾切开取石术。对于这种情况，我们无法使用软性输尿管镜。
手术时间为 150 分钟。插入顺行 JJ 支架，并使用薇乔 4-0 进行肾盂缝合。患者未使用阿片类药物，并于术后第一天出院。1 个月后取出 JJ 支架，临床症状完全缓解。
腹腔镜肾切开取石术是治疗肾盂下极大结石患者的一种极好的治疗选择。
