Classification of kidney stone surgery

Treatment is divided into: traditional open surgery and minimally invasive surgery, 1, pyelolithotomy: it is suitable for patients with intrarenal pyelolithiasis, huge extrarenal pyelolithiasis and extrarenal pyelolithiasis with intrarenal calculi and obvious dilatation of renal calyceal funnel.

2, renal parenchyma incision lithotomy: suitable for staghorn renal pelvis renal calices stones or multiple stones in renal calices, stones that cannot be taken out through renal pelvis or are difficult to take out. In order to reduce bleeding, the renal parenchyma is usually cut at the thinnest part of the renal parenchyma or the nearest place to the stone.

If necessary, measures such as temporarily blocking renal blood flow and local cooling should be taken to reduce bleeding.

3. Partial nephrectomy: For multiple stones confined to the upper renal calyx or the lower renal calyx, especially when the neck of the renal calyx is narrow, partial nephrectomy is feasible, and the upper renal pole or the lower renal pole is removed together with the stones.

4. Nephrectomy: For severe hydronephrosis caused by unilateral renal or ureteral stone obstruction, the renal cortex is thin; Complicated with infection, resulting in pyonephrosis and complete loss of renal function. If the contralateral renal function is normal, nephrectomy can be performed. Minimally invasive surgery mainly adopts endoscope and holmium laser treatment. Common minimally invasive surgical treatment is divided into:

1. Fiber soft nephrolithotomy is to put a rigid ureteroscope through the external urethral orifice, explore the bladder, find the right ureteral orifice, put a zebra guide wire, put a soft endoscope, expand the outer sheath under the guidance of the zebra guide wire, put a soft endoscope into the renal pelvis through the outer sheath, explore the famous renal calyx, and find the upper calyx. Under the combined action of Nd laser and Holmium laser, stones were crushed, and some stones were taken out by soft endoscope with stone mesh and three-jaw pliers. Double J tube was inserted and the operation was successfully completed. Safe and non-invasive, clean stone removal can quickly restore your health and greatly reduce the recurrence rate. 2. Percutaneous nephrolithotomy requires the use of high-tech percutaneous nephrolithotomy equipment, which has the advantages of high surgical safety, short hospitalization time and wide surgical indications. The application of flexible ureteroscope can reach almost all renal calices, thus improving the stone clearance rate, reaching more than 95%. A little traumatic. Less bleeding, fewer complications and less trauma.

3. Ureteroscopic lithotripsy is a slender and high-precision instrument that is sent to the bladder through urethra and reaches the ureter with a diameter of only 0.2 to 0.5 cm. Under direct vision or with the help of TV monitoring system, the stones in ureter can be clearly observed, and then the lithotriptor, stone net and stone forceps are inserted from the working cavity of ureteroscope to take out the stones crushed by laser.

4. The lithotripsy effect of Holmium laser lithotripsy technology on stones mainly depends on thermal effect. In the process of lithotripsy, the water on the surface of the stone and the water in the stone absorb the energy of Holmium laser to vaporize to form small balls, and the shock wave formed by the subsequent cracking of the vaporized balls generates secondary pressure, which breaks the stone. The rate of lithotripsy in a single operation is over 95%, and its tissue penetration depth is

The application scope of Holmium laser mainly includes:

(1) Urinary calculi of any composition, any part and any size.

(2) Failure of extracorporeal lithotripsy.

(3) The effect of pneumatic ballistic therapy is not significant.

(4) Obstruction with polyps and stenosis lasts for a long time.

(5) Stones in pregnant women, children, hemorrhagic constitution and other special groups.