摘要
目的探讨微创经皮肾镜钬激光碎石联合肾盏憩室颈切开治疗肾盏憩室结石的临床疗效。方法回顾分析我院采用微创经皮肾镜钬激光碎石联合肾盏憩室颈部狭窄切开治疗22例肾盏憩室结石患者的临床资料,总结肾盏憩室结石微创治疗的经验和对策。本组患者女性10例,男性12例;平均年龄35.6岁。其中肾上盏憩室结石10例,肾中盏憩室结石5例,肾结石合并肾盏憩室结石7例。采用B超定位引导直接穿刺结石所在之肾盏憩室,应用钬激光碎石,同时以钬激光切开憩室颈部狭窄。结果7例肾结石合并肾盏憩室结石患者中,5例行一期双通道取石,2例行二期经皮肾镜取石;余15例患者均一期微创经皮肾镜成功取石。术后复查22例均无结石残留。手术时间为25～120min,平均45min;术中出血15～80ml,平均35ml。无术后严重并发症发生,无中转开放手术病例,术后7～12d出院。结论微创经皮肾镜钬激光碎石创伤小,清除结石的同时可以应用钬激光行肾盏憩室颈部狭窄的切开,为有症状的肾盏憩室结石患者提供一种微创治疗的选择。
Objective To investigate the safety and feasibility of mini mally invasive percutaneous nephrolithotripsy（MPCNL）in the treatment of caliceal diverticular calculi. Methods In all, 22 patients （12 males and 10 females, average age 35.6 years old） who had MPCNL treatment of symptomatic caliceal diverticular calculi were retrospectively analyzed. The stone-bearing diverticula were in the upper calices in 10 and middle calices in 5 patients, and other 7 patients were with multiple renal calculi and caliceal diverticular calculi. Stones were removed intact or fragmented with holmium laser lithotripsy by MPCNL under the B type ultrasonograph guidance in all patients, and the diverticular necks were incised with holmium laser and placed with a 16 F nephrostomy tube for several days.Results Two percutaneous access pathways were used in 5 patients with multiple renal calculi and caliceal diverticular calculi. Twenty cases had a MPCNL and were rendered stone-free at one session, only 2 cases needed a second nephroscopy for the residual stone. The average operating time was 45 min（25-120 min） and the average blood loss was 35 ml （15-80 ml）. No severe complications occurred in all patients. None need to transfer to open surgery during the operation. The hospital stay after surgery was 7-12 days.Conclusions MPCNL might be an effective and feasible treatment option with less invasion and high stone-free rate for symptomatic caliceal diverticular calculi in selective cases.
出处
《中国激光医学杂志》
CAS
CSCD
2010年第2期110-113,136,共5页
Chinese Journal of Laser Medicine & Surgery
关键词
经皮肾镜碎石术
钬激光
肾盏憩室结石
Percutaneous lithotripsy
Holmium laser
Renal calyceal diverticular calculi
