开放手术治疗上尿路结石667例回顾分析

摘要

Objective To summarize the efficacy of open stone surgery for renal and ureteral calculi, and to investigate the current indications for upper urinary tract stones treated by open stone surgery. Methods To analyze retrospectively the cases with upper urinary tract calculi treated by open stone surgery from January 1995 to December 2004. Results In all,there were 667 patients treated for renal and ureteral calculi by open stone surgery, at the same time 9000 cases with upper urinary tract calculi also treated in our centre with open surgery rate 7.4%. Indications for open surgery were complex stone burden of 297 cases, nephrectomy for non-functioning kidneys of 137 cases, with anatomical abnormalities of 134 cases, ESWL or endoscopy failure of 57 cases ,with co-morbid medical diseases of 30 cases,with renal carcinoma of 5 cases, with xanthogranulomatous pyelonephritis of 3 cases,with kidney injury of 2 cases, and with other ipsilateral operation of 2 cases. Of 145 cases for nephrectomy, 16 patients and 6 patients suffered from various intraoperative and postoperative complications respectively; of 522 patients treated by open stone surgery, 7 patients and 34 patients were suffered from various intraoperative and postoperative complications respectively;57 patients with multiple renal calculi had residual calculi with overall stone-free rate 89.1%. And no case died in perioperative period. Conclusious Open surgery maintains its important role for treatment of renal and ureteral calculi because of its salty and efficacy. Nephrectomy for nonfunctioning kidney with renal and/or ureteral calculi, huge and complex renal calculi, anatomical abnormalities, minimal invasive therapies failure and some selective patients with co-morbid medical diseases are suitable for open stone surgery with high success and low morbidity rate.%目的 总结开放手术治疗上尿路结石的有效性,探讨在微创时代开放手术治疗上尿路结石的手术适应证.方法 回顾分析1995年1月至2004年12月在四川大学华西医院泌尿外科行开放手术治疗的上尿路结石病例.结果 共667例上尿路结石行开放手术治疗,同期约有9000例上尿路结石病例在我科治疗,开放手术比例约7.4%.开放手术原因包括:复杂结石及巨大结石297例,结石致患肾无功能137例,结石合并上尿路解剖畸形134例,微创治疗失败57例,结石合并各种内科疾病30例,结石合并肾肿瘤5例,结石合并黄色肉芽肿性肾盂肾炎3例,结石合并肾外伤2例,结石合并同侧其他手术2例.145例肾切除病例中共16例出现术中并发症,6例出现术后并发症;522例肾输尿管切开取石病例中,7例出现术中并发症,34例出现术后并发症;术后57例结石残留,总结石清除率为89.1%;围手术期无一例死亡.结论 开放手术在上尿路结石的治疗中仍然有重要作用,结石性无功能肾切除、复杂及巨大肾结石、结石合并解剖畸形、微创治疗失败及合并内科疾病的部分选择性病例适合选择开放手术治疗,治疗效果确切,并发症低.