Zahm M J, Bueschen A J, Lloyd L K, Witten D M
J Urol. 1981 Mar;125(3):284-6. doi: 10.1016/s0022-5347(17)55010-7.
Complete surgical removal of staghorn or multiple renal calculi is extremely difficult. Intraoperative roentgenography has been used to decrease the incidence of residual calculi. We herein assess the effectiveness of intraoperative roentgenography and emphasize important operative technical aspects. Between 1973 and 1979, 42 patients underwent 50 operations for the removal of staghorn or multiple renal calculi. Intraoperative roentgenography was used in 47 operations and omitted in 3. Of the 47 operations done with intraoperative roentgenography 31 units were free of stones and 12 had small retained fragments known intraoperatively with verification by postoperative tomography or plain abdominal film. In 1 case of calculus recognized intraoperatively passed during the postoperative period and tomograms demonstrated no residual calculi. Only 3 patients had residual stones postoperatively with negative intraoperative films. The 3 patients who did not have intraoperative roentgenography all had residual fragments. All 3 kidneys were thought to be free of residual stones as determined by visual inspection and nephroscopy. With the aid of intraoperative roentgenography the incidence of residual stones was 23 per cent. Followup for up to 6 years in 45 renal units showed 73 per cent to be free of stones. When properly used intraoperative roentgenography is highly accurate. Films should be obtained before any stones are removed and care should be taken to x-ray the entire kidney even if 2 films are required. Final films should be obtained after all fragments are removed.
完全手术切除鹿角形或多发性肾结石极其困难。术中X线摄影已被用于降低残余结石的发生率。我们在此评估术中X线摄影的有效性，并强调重要的手术技术方面。1973年至1979年间，42例患者接受了50次鹿角形或多发性肾结石切除术。47例手术使用了术中X线摄影，3例未使用。在47例使用术中X线摄影的手术中，31个单位无结石，12个单位有小的残留碎片，术中已知，术后经断层扫描或腹部平片证实。1例术中发现的结石在术后排出，断层扫描显示无残余结石。只有3例患者术后有残留结石，术中X线片为阴性。3例未进行术中X线摄影的患者均有残留碎片。通过肉眼检查和肾镜检查，所有3个肾脏均被认为无残留结石。借助术中X线摄影，残留结石的发生率为23%。对45个肾单位进行了长达6年的随访，结果显示73%的肾单位无结石。如果使用得当，术中X线摄影的准确性很高。应在取出任何结石之前拍摄X线片，即使需要拍摄两张片子，也应注意对整个肾脏进行X线检查。在取出所有碎片后应拍摄最终X线片。
