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首页> 外文期刊>BJU international >Laparoscopic anatrophic nephrolithotomy for managing large staghorn calculi.
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Laparoscopic anatrophic nephrolithotomy for managing large staghorn calculi.

机译：腹腔镜萎缩肾镜取石术治疗大型鹿角结石。

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OBJECTIVES: To evaluate the efficacy of a laparoscopic approach for managing large staghorn renal calculi. PATIENTS AND METHODS: Laparoscopic transperitoneal anatrophic nephrolithotomy was used to duplicate open anatrophic nephrolithotomy in five patients (three men) with large staghorn renal stones unsuitable for percutaneous nephrolithotomy. Only the renal artery was clamped, using a bulldog clamp. The stone was removed through a nephrotomy incision on the Brodel line, which was closed using 3/0 polyglactin continuous sutures, and sutures were buttressed by haemostatic clips instead of knots. Intraoperative ultrasonography was used in the last two patients to evaluate residual stones. RESULTS: The mean (range) stone size was 53 (45-65) mm, the patient age was 53 (45-58) years, and the warm ischaemia and operative duration were 32 (29-35) and 170 (120-225) min, respectively. No blood transfusion was needed during or after surgery. All of the procedures were uneventful and there was no urine leakage after surgery. Only an 8-mm and a 6-mm residual stone remained in the first and third patients, in the lower and middle calyces, respectively. Both of them were subsequently treated with shock wave lithotripsy. An intravenous pyelogram after surgery showed a functional corresponding renal unit, with a significant improvement in obstruction in all patients. CONCLUSION: Laparoscopic anatrophic nephrolithotomy is a promising alternative for patients who are candidates for open surgery, with an acceptable stone-free rate. While offering a minimally invasive approach, it can minimize the need for secondary invasive interventions. Further patients and a longer follow-up are needed before this is suggested as the preferred method in selected patients in the future.
机译：目的：评估腹腔镜治疗大鹿角肾结石的疗效。病人和方法：腹腔镜经腹腔镜全肾镜取石术用于复制5例（3名男性）大型鹿角肾结石不适合经皮肾镜取石术的开放性全脂膜肾镜取石术。使用牛头犬钳仅夹住肾动脉。通过Brodel线上的肾切开术切口去除结石，该结石使用3/0聚乳酸连续缝合线闭合，并用止血夹代替结来支撑缝合线。最后两名患者使用术中超声检查来评估残余结石。结果：平均（范围）结石大小为53（45-65）mm，患者年龄为53（45-58）岁，温暖的局部缺血和手术时间分别为32（29-35）和170（120-225） ）分钟。手术期间或之后无需输血。所有过程均顺利进行，术后无尿液漏出。在第一和第三名患者中，在下肾盏和中肾盏中分别仅剩下8毫米和6毫米的残余结石。随后，他们两个都接受了冲击波碎石术治疗。手术后静脉肾盂造影显示相应的肾单位功能正常，所有患者的梗阻均有明显改善。结论：腹腔镜厌食肾镜取石术是可以接受开放手术的患者的有希望的替代方法，无结石的发生率可以接受。在提供微创方法的同时，它可以最大程度地减少对二次侵入性干预的需求。在建议将其作为将来某些患者的首选方法之前，需要进一步的患者和更长的随访时间。

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