摘要
目的探讨超声引导经皮肾盏憩室穿刺辅助输尿管软镜（FUS）治疗肾盏憩室结石的临床价值。方法回顾性分析2014年8月-2015年5月共9例FUS下寻找憩室开口困难患者。其中,男6例,女3例,中位年龄50岁（27~83岁）。结石最大径中位数为12 mm（6~24 mm）。患者斜截石位,应用超声辅助穿刺憩室并注入美兰或插入导丝辅助FUS治疗憩室结石。结果 9例患者均经超声引导穿刺憩室成功。6例经针鞘注入美兰后输尿管镜下可见蓝色液体自憩室口流出,3例未见蓝色液体流出。后3例经穿刺针鞘置入导丝引导输尿管镜辨认憩室位置,于壁薄处切开。9例患者均成功用钬激光切开憩室颈口或憩室壁以充分引流,击碎并取出憩室内结石。无石率、碎石成功率和无症状率分别为77.8%（7/9）、88.9%（8/9）和100.0%（7/7）。中位住院时间为3 d（2~5 d）。术后1例发热经抗生素治疗后好转。术后3个月4例憩室消失,5例憩室缩小。结论超声引导穿刺可能有助于FUS辨认肾盏憩室开口和位置,可能有助于提高FUS的手术成功率和减少手术并发症。
Objective To evaluate the value of flexible ureteroscope for management of renal calyceal diverticulum calculi with ultrasound guided puncture of diverticulum. Methods From August 2014 to May 2015, six men and 3women, median age 50 years, with 7 symptomatic caliceal diverticulum calculi and 2 symptom free, were treated by flexible ureteroscopic methods. Flexible ureteroscope recognization of diverticulum ostium with the help of ultrasound guided puncturing into diverticular cavity in lateral lithotomy position were performed. After the needle entering the diverticula cavity, saline-diluted methylthioninium chloride was injected or guidewires were inserted gently through needle sheaths. At the same time, the orifice or wall of the diverticular cavity was recognized under flexible ureteroscope. A 200-mm holmium laser fiber is used to fragment large diverticular calculi, larger fragments were extracted with basket. Laser incise the stenotic infundibulum or diverticular wall. Results Of the 9 cases, calyceal diverticulum necks leading to calyx were identified in 6 cases, another 3 cases were not found but determined their locations. The thinker diverticular walls of the later 3 cases were incised with laser. The stone free rate, fragment success rate and symptom free rate was 77.8%（6/9）, 88.9%（8/9） and 100.0%（7/7）, respectively. Only one case were underwent repeated procedure for the residual fragments, and the fragments were all cleared successfully. Diverticula became disappeared or shrinked in 4 and 5 cases 3 months postoperation, respectively. Conclusion Flexible ureteroscope combining with the ultrasound guided puncture of diverticular cavity for management of caliceal diverticula may provide a safe and effective option. Ultrasound guided needle puncture into calyceal diverticula may facilitate flexible ureteroscopic treatment of renal calyceal diverticula calculi.
出处
《中国内镜杂志》
北大核心
2016年第4期90-94,共5页
China Journal of Endoscopy
关键词
肾盏憩室
肾盏憩室结石
输尿管软镜
经皮肾镜取石术
穿刺
超声
calyceal diverticulum
calyceal diverticulum calculi
flexible ureteroscope
percutaneous nephrolithotomy
puncture
ultrasound
