【摘要】 目的探讨经皮肾镜超声碎石联合肾盏憩室颈切开术在肾盏憩室结石治疗中的安全性及疗效。方法回顾性分析2009年7月至2015年7月我院泌尿外科收治的25例肾盏憩室结石患者的临床资料,在B超引导下穿刺结石所在的肾盏憩室,予以超声碎石,采用钬激光切开憩室颈口,术后留置肾造瘘管及双J管。评价结石清除率、并发症、术前术后肾功能变化。结果 25例患者均采用一期单通道成功碎石。手术时间为30~130 min,平均(70.4±29.9)min;术中出血20~200 ml,平均(49.6±41.9)ml。无大出血或周围脏器损伤等严重并发症发生,无中转开放手术病例,结石清除率为92%(23/25),随访3~24个月,所有患者憩室消失或变小;患者术后血肌酐(68.40±13.82)μmol/L、尿素氮值(5.64±2.31)mmol/L明显低于术前[(90.12±19.68)mmol/L,(7.92±2.82)mmol/L],24 h尿量高于术前,差异均有统计学意义[(1 515.28±272.59)ml vs(1 214.56±304.14)ml,P<0.05]。结论经皮肾镜超声碎石联合肾盏颈切开治疗肾盏憩室结石创伤小、并发症少,效果确切。更多还原

【Abstract】 Objective To investigate the safety and clinical efficacy of percutaneous ultrasonic nephrolithotomy combined with caliceal diverticular neck incision for the treatment of renal caliceal diverticular calculi. Methods The clinical data of 25 patients of renal caliceal diverticular calculi treated by percutaneous ultrasonic nephrolithotomy combined with caliceal diverticular neck incision were retrospectively analyzed. The corresponding diverticulum was penetrated under the guidance of B type ultrasonography. Stones were fragmented with ultrasonic nephrolithotomy by PCNL and the diverticular necks were incised with holmium laser. Trans-diverticular percutaneous drainage and double-J stent were placed postoperatively. The outcome, complications, and renal function changes were analyzed. Results All the 25 patients were rendered stone-free at one session. The whole duration of the operation was 30~130 min, with an average of(70.4±29.9) min,and the blood loss was 20~200 ml, with an average of(49.6±41.9) ml. No severe complications such as massive hemorrhage or adjacent organ damage occurred, and no patient was transferred to open surgery during the operation. The total stone clearance rate was 92%(23/25). Postoperative IVU showed obliteration of diverticula or improved drainage in all cases during the follow-up of 3 to 24 months. The postoperative serum creatinine [(68.40±13.82) μmol/L] and blood urea nitrogen [(5.64±2.31) mmol/L] were significantly lower than those of the patients preoperatively [(90.12±19.68) mmol/L,(7.92±2.82) mmol/L], while the postoperative 24 h urine volume were significantly higher [(1 515.28±272.59) ml vs(1 214.56±304.14) ml, P<0.05]. Conclusion Percutaneous ultrasonic nephrolithotomy combined with caliceal diverticular neck incision is effective for caliceal diverticular calculi, with small incision and low incidence of complications.更多还原