The morphology of renal lobulations and calices, and their relationship to partial nephrectomy
The morphology of renal lobulations and calices, and their relationship to partial nephrectomy
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肾小叶和肾盏的形态及其与肾部分切除术的关系
DOI：
10.1002/bjs.1800510409
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发表时间：
1964
影响因子：
9.6
通讯作者：
D. Sykes
中科院分区：
文献类型：
--
作者：
D. Sykes
外科技术的进步最坚实的基础是对相关组织的结构和功能的精确研究。当然，这一点也适用于肾部分切除术。肾结石是肾部分切除术最常见的指征。在Hanley(1950)和Stewart(1956)的系列中，80%的肾部分切除是由于这种情况而进行的。对于这种病理状态，手术的原则是移除足够的肾盏系统和周围的肾组织，以防止进一步的结石形成。不同的外科医生在手术过程中切除的肾实质的数量有很大的不同，这从他们对肾脏切开应该是横形还是楔形的不同意见中可见一斑。肾结石最常发生的部位是肾盏下部。使用“发生”这个词是经过深思熟虑的，因为与继发性结石不同，原发肾结石最初可能形成于肾实质(Carr，1954)。斯图尔特(1955)描述了73%的肾结石是如何单独发生在肾下盏的，在他的系列文章的另外11%中，与肾脏其他区域的结石有关。根据Stewart(1955)的说法，为了去除下肾盏上的原发结石并防止该区域进一步形成结石而进行的肾部分切除，必须包括整个下大肾盏及其所有相关的小肾盏的切除。这与对上肾盏原发结石进行部分肾切除术形成对比，在上肾切除中，只需切除受影响的小肾盏和相关的肾实质，尽管从技术上讲，移除上大肾盏及其相关的小肾盏更容易。只有在必须保存肾组织的情况下，才会使用前一种方法。斯图尔特已经明确了在手术治疗肾结石时应该切除多少肾盏系统，但还没有工作来确定应该同时切除多少肾实质。鲸目动物的肾脏是一个节段性器官，类似于黑莓。许多小叶由纤维组织连接；每个小叶包含一个管口，由肾动脉的单一分支供应，由肾静脉的单一支流引流。在这样的肾脏上进行部分肾切除不会有任何问题。胎肾中的分叶可能是残留的结构或代表肾组织潜在节段性排列的表面斑纹。如果后者是正确的，那么在部分肾切除术中切除多少肾实质的问题就解决了
ADVANCES in surgical techniques are based most firmly on precise researches into the structure and function of the tissue concerned. Most certainly this applies to the procedure of partial nephrectomy. The presence of renal calculi is the most frequent indication for partial nephrectomy. In Hanley’s (1950) series, and also in Stewart’s (1956) series, 80 per cent of partial nephrectomies were undertaken for this condition. The principle of the operation, as performed for this pathological state, is to remove sufficient of the caliceal system and surrounding renal tissue to prevent further stone formation. The amount of renal parenchyma excised in the course of this operation varies considerably among surgeons, as evidenced by their divergence of views on whether the renal incision should be transverse or wedgeshaped. The most frequent site for renal stones to occur is in the lower calices. The word ‘occur’ is used advisedly, since primary renal stones, in contrast to secondary stones, are probably formed initially in the renal parenchyma (Carr, 1954). Stewart (1955) has described how 73 per cent of renal stones occur in the lower calices alone, and, in a further 11 per cent of his series, in association with stones in other regions of the kidney. According to Stewart (1955)~ a partial nephrectomy performed to remove primary stones from the lower calices, and also to prevent further stone formation in this region, must include the excision of the whole of the lower major calix with all its associated minor calices. This is in contrast to a partiaI nephrectomy performed for a primary stone in the upper calices, where it is necessary to remove only the affected minor calices and associated renal parenchyma, although it is technically easier to remove the superior major calix with its associated minor calices. The former procedure is used only if it is essential to conserve renal tissue. Stewart has defined exactly how much of the caliceal system should be removed when operating for renal stones, but no work is available to define how much of the renal parenchyma should be excised concurrently. The Cetacean kidney is a segmental organ that resembles a blackberry. A number of lobules are connected by fibrous tissue; each lobule contains one calix, and is supplied by a single branch of the renal artery and drained by a single tributary of the renal vein. A partial nephrectomy performed on such a kidney would present no problem. The lobulations in the foetal kidney may be vestigial structures or represent surface markings of an underlying segmental arrangement of renal tissue. If the latter is correct then the problem of how much renal parenchyma to resect in a partial nephrectomy, performed