単腎症例における珊瑚状結石に対する腎保存手術について

Abstract

Seven patients undergoing surgical removal of extensive renal calculi involving a solitary kidney are reviewed. Problems arising from the surgery for the extensive renal calculi in a solitary kidney patient are demonstrated and indication of the surgery is also discussed. From January, 1978 to July, 1984, extensive renal calculi were removed in 7 solitary kidney patients. The operative technique for removing calculi consisted of anatrophic nephrolithotomy (in 2 patients) and ex vivo surgery (in 5 patients). There were 2 operative deaths and 2 major complications. Calculi were completely removed in 6 and 1 patient undergoing anatrophic nephrolithotomy, had a 3 X 4 mm residual calculus. The postoperative serum creatinine was improved in 5 patients. These major complications were observed in the patients who had severe renal dysfunction during the early postoperative period. It was indicated that good renal function should be maintained even during the early postoperative period in the surgery on a solitary kidney patient. Investigating injury to the operated kidney, the early postoperative serum creatinine level was analysed in these 7 patients and 3 patients undergoing ex vivo surgery for removal of aneurysm in a solitary kidney. The results indicated that nephrotomy was the most extensive damage to the kidney. However, pyelotomy and cold ischemia during ex vivo surgery, are not always harmful. In performing surgery for extensive renal calculous disease involving a solitary kidney, we should choose pyelotomy rather than nephrotomy in in situ operation. Ex vivo surgery can provide an effective treatment.