Klosterhalfen H, Wagenknecht L V, Busch R
Eur Urol. 1981;7(4):206-10. doi: 10.1159/000473220.
Coagulum pyelolithotomy is a time-saving and tissue-conserving method which minimizes the danger of small crystallizations being left behind for new stone formation. A coagulum of excellent elasticity and tenacity can be obtained from the following mixture: first syringe, 20 ml thrombocyte-enriched plasma plus 5 ml human fibrinogen, and second syringe, 1 ml thrombin plus 4 ml calcium chloride. During the last 7 years this procedure has been employed in 120 selected patients; of these 84 involved multiple stones and 36 a single stone in a dilated intrarenal system. In only six cases were there residual caliceal fragments. The risk of hepatitis seems to be negligible since (1) only HBsAG-negative plasma and blood extracts are used, and (2) a comparison of two groups of 120 pyelolithotomies, with and without the coagulum, showed only two cases of hepatitis in each group while preoperative hepatitis occurred in five and seven cases, respectively. The enzymatic action or urokinase ensures that missing fibrin particles are dissolved before encrustation can occur. All free stones are caught and extracted with the coagulum. In 23% of cases additional fragments, not indicated by preoperative X-rays, were extracted as well.
凝块肾盂切开取石术是一种节省时间且保留组织的方法，可将残留小结晶形成新结石的风险降至最低。可通过以下混合液获得具有出色弹性和韧性的凝块：第一支注射器，20毫升富含血小板的血浆加5毫升人纤维蛋白原；第二支注射器，1毫升凝血酶加4毫升氯化钙。在过去7年中，该手术应用于120例选定患者；其中84例为多发结石，36例为肾盂扩张系统中的单个结石。仅6例有残留肾盏碎片。肝炎风险似乎可忽略不计，原因如下：（1）仅使用HBsAG阴性的血浆和血液提取物；（2）对两组各120例进行凝块肾盂切开取石术的患者进行比较，一组使用凝块，另一组未使用，结果两组各仅出现2例肝炎病例，而术前肝炎分别发生在5例和7例患者中。尿激酶的酶促作用可确保在结壳形成之前溶解缺失的纤维蛋白颗粒。所有游离结石都被凝块捕获并取出。在23%的病例中，还取出了术前X线未显示的额外碎片。
