Nephrolithotomy For Management Of Staghom Calculi With Block Of Renal Blood Flow At Usual Temperature

Background:Urolithiasis is one of China's most common diseases of urology,and renal calculi accounted for the vast majority.According to the incidence of renal calculi in china, in recent years its incidence rate is still rising.The national academic study of how to improve the treatment of renal calculi effectively has attract the world's attention.In the 1970s and early 1980s,for the renal calculi that with ineffective drug therapy, open surgery is the only treatment option.The last 30 years,with extracorporeal shock wave lithotripsy(ESWL)and endourological techniques such as percutaneous nephrolithotomy(PCNL)technology used in clinical,the treatment of renal calculi has undergone tremendous changes.Open surgery has significantly reduced,and these more minimally invasive treatment of urological become the first option.However, the treatment of the complex renal calculi is still a problem,many reports have confirmed that these minimally invasive technique still cause varied degrees of renal dysfunction and high rate of residual calculi.For those calculi that ESWL treatment failed and not suitable for the treatment of PCNL and ureteroscopy is still need open surgery,particularly staghorn calculi.Methods:1.Cases and exclusion criteria included:1.1 The included standardsStaghorn calculi definition:is a pelvis full of calculi and at least one renal calyceal with calculi.Part of these staghorn calculi only fill part of collecting system, complete staghorn calculi fill the whole renal collecting system.1.2 The exclusion criteriaDuring surgery at the same time,rule out these such as cholecystectomy surgery,gynecology surgery cases,in order to avoid the interference of the statistical data.2.Case collectionCollected from January 2005 to March 2008,a total of 18 cases done by nephrolithotomy with block of renal blood flow at usual temperature for management of staghom calculi,a detailed record of the name,gender,age,home address,telephone number,diagnosis,the merger disease,operative methods,date of surgery,amount of bleeding,postoperative complications,and postoperative analgesic use,days of intravenous antibiotics,days of postoperative peritoneal cavity drainage tube,the hospitalization time after operative,intravenous urography,CT renal ECT results,and other items.Results:All of the cases were successfully removed of calculi,operation time was 90-150min,120min average,no intraoperative blood transfusion,block of renal blood flow in 10-20 min(including intermittent block times),intraoperative bleeding 80-360ml;no intraoperative and postoperative blood transfusion,no postoperative renal hematoma or urine leakage,Incisional fat liquefaction occurred in 1 case.,the group were cured and discharged,the hospitalization time lasts 12-18 days,removal of the Double J Ureteral Catheter of 2 month after the surgery.X-ray examination showed two cases of small residual renal calyceal calculi,one case without further treatment,another one with extracorporeal shock wave lithotripsy(ESWL)and drugs was cured.Follow-up of 6-20 months,according to preoperative examination IVU exam,reviewed 16 cases of IVU hydronephrosis significantly improved,only two cases's improvement was not obvious,Doppler ultrasound or CT scan all find no renal cortical atrophy.Conclusion:The surgery method of nephrolithotomy for staghom calculi with block of renal blood flow at usual temperature has high success rate of operations with less bleeding,as traditional open surgery for staghorn calculi,is still an effective treatment method.