Paik M L, Resnick M I
Department of Urology, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
Tech Urol. 1997 Summer;3(2):96-9.
The establishment of extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy, and ureteroscopy as the primary treatment modalities for almost all renal and ureteral calculi has greatly diminished the role of open stone surgery. We reviewed our most recent experiences with open stone surgery to determine the current indications and to establish what role open surgery plays in the management of urolithiasis. We conducted a retrospective review of all patients undergoing open stone surgery during a consecutive 60-month period from 1991 through 1995 at three university-affiliated hospitals. Hospital and office charts, operative notes and records, and pertinent radiographic studies were reviewed. Of the 780 therapeutic stone procedures performed, 42 were open surgical procedures (5.4%), including pyelolithotomy [15], anatrophic nephrolithotomy [14], ureterolithotomy [7], and radial nephrolithotomy [6]. The most common indications for open stone surgery were complex stone burden, previous treatment failures with less-invasive modalities, anatomical abnormalities involving the renal collecting system, and patient comorbid medical problems. The stone-free rate following open surgery was 93%. There were five complications. Based on our experience, we discuss our current indications for open stone surgery.
体外冲击波碎石术（ESWL）、经皮肾镜取石术和输尿管镜检查已成为几乎所有肾和输尿管结石的主要治疗方式，这大大降低了开放性结石手术的作用。我们回顾了我们最近在开放性结石手术方面的经验，以确定当前的适应症，并确定开放性手术在尿路结石管理中所起的作用。我们对1991年至1995年连续60个月期间在三家大学附属医院接受开放性结石手术的所有患者进行了回顾性研究。查阅了医院和门诊病历、手术记录和相关影像学研究。在780例治疗性结石手术中，42例为开放性手术（5.4%），包括肾盂切开取石术[15例]、无萎缩性肾切开取石术[14例]、输尿管切开取石术[7例]和放射状肾切开取石术[6例]。开放性结石手术最常见的适应症是结石负荷复杂、先前采用侵入性较小的治疗方式失败、涉及肾集合系统的解剖异常以及患者合并的内科疾病。开放性手术后的结石清除率为93%。有5例并发症。基于我们的经验，我们讨论了目前开放性结石手术的适应症。
