腹腔镜下配合肾盂拉钩行肾盂切开取石术治疗无肾盂积水肾内型肾盂结石：附视频

目的 总结腹腔镜下配合肾盂拉钩行肾盂切开取石术治疗无肾盂积水肾内型肾盂结石初步经验.方法 在腹腔镜下配合肾盂拉钩行肾盂切开取石术治疗无肾盂积水肾内型肾盂结石23例,回顾分析23例病例资料.结果 23例手术均取得成功,手术时间（53±19）min,出血量（50±15） ml,平均住院时间（8±2）d,无一例漏尿,无一例中转开放手术,无输血病例等情况,随访除1例肾下盏残留0.7 cm结石外,其余无结石残留.结论 腹腔镜下配合肾盂拉钩行肾盂切开取石术治疗无肾盂积水肾内型肾盂结石可行,选择合适病例,术中操作快速,适当游离、牵拉暴露肾内型肾盂,可以有效避免开放手术、经皮肾镜等手术重创,此种手术方式术后恢复快、疗效确切,值得推广.     

Laparoscopic pyelolithotomy – A technique for the management of stones in the ectopic pelvic kidney

We present our preliminary experience with the technique of laparoscopic pyelolithotomy for ectopic pelvic kidney calculi. This surgery has low morbidity and is ideally suited for the ectopic pelvic kidney with a laterally or anteriorly directed pelvis.     

Laparoscopic transmesocolic pyelolithotomy in an ectopic pelvic kidney.

Management of large calculi in ectopic pelvic kidneys poses a challenge to the urologist. Risk of injury to surrounding abdominal viscera and vasculature makes open surgery as well as percutaneous nephrostolithotomy in an ectopic kidney a challenging procedure. Laparoscopic management avoids open surgery and associated morbidity and offers added safety. We report the management of symptomatic stones in a pelvic ectopic kidney lying anterior to the L5 vertebra and sacrum by transmesocolic laparoscopic pyelolithotomy in an 11-year-old child. Complete stone clearance was achieved with no complications and an uneventful postoperative recovery. The patient was discharged 72 hours after the surgery.     

Laparoscopic pyelolithotomy in a horseshoe kidney

A 66-year-old woman had a 22 mm right kidney stone accompanied with a horseshoe kidney. The size of this stone had been increasing gradually from 7 mm to 22 mm during the past 5 years. Although apparent pelviuretic junction stenosis could not be identified by intravenous urography, external pelvis was dilated in both kidneys. Complete excretion of fragmented stones by extracorporeal shockwave lithotripsy seemed to be difficult because impaired urinary passage from the renal pelvis to the ureter was suspected. Percutaneous nephrolithotomy was also difficult due to malrotation of the pelvic-caliceal system and possible interposition of bowel loops between kidney and abdominal wall. Therefore, we chose laparoscopic pyelolithotomy. This procedure made it possible to remove the stone completely with minimum invasiveness. We assume that laparoscopic pyelolithotomy is a safe and effective approach for renal pelvic stone in case of horseshoe kidney.     

The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones

The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large (>4?cm(2)) renal pelvic stones were treated by LPL and their charts were compared to 26 match-paired patients treated with PNL during the same period. The patients were matched for age, BMI, stone size and location as well as presence of congenital anomalies. Perioperative and postoperative findings were compared. The mean age, mean stone size, rate of congenital anomalies, history open renal surgery and shock wave lithotripsy were similar in both groups (p?>?0.05). The mean operation time was 138.40?±?51.19 (range 70-240)?min in LPL group as compared to 57.92?±?21.12 (range 40-110)?min in PNL group (p?相似文献   

Laparoscopic nephrectomy for a nonfunctioning pelvic kidney in preparation for renal transplantation.

Pelvic kidneys pose a problem for any planned surgical intervention given their anomalous blood supply. Although minimally invasive approaches have been described for the management of benign conditions, only a handful of reports have described the use of laparoscopy for removal of ectopic or fused kidneys. We describe the laparoscopic removal of a symptomatic pelvic kidney in a patient before renal transplantation.     

Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney

Treatment of patients with solitary kidney having complex stones is one of the most challenging problem in urology. We present our experience with percutaneous nephrolithotomy (PCNL) in treating 16 patients with staghorn stones in a solitary kidney to determine long-term renal functional results. We retrospectively reviewed the records of 16 patients with complex caliceal or staghorn stones in a solitary kidney treated with PCNL. Demographic data, number and location of accesses, hemoglobin values, stone analyses, and complications were studied. Serum creatinine, glomerular filtration rate (GFR), systolic and diastolic blood pressure, new onset hypertension, and kidney morphology were determined preoperatively and postoperatively at 1 month and 1 year. Male to female ratio was 14:2 and mean age was 49.6 years (range 31–55). Of these, 10 (62.5%) patients required a single tract, while 6 (37.5%) required multiple tracts. The calculi were extracted or fragmented successfully in 13 (81.3%) patients and complete stone clearance was achieved after the first stage. In two patients with residual calculi, a double-J catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was performed. There were no significant intraoperative problems except in one patient, who had bleeding from an infundibular tear attributable to torquing. During the 1-year study period, none of the patients progressed to end-stage renal disease requiring dialysis. We demonstrated a significant improvement in creatinine and GFR levels from preoperatively to 1-year follow-up. The number of patients with hypertension before PCNL was 5 and by the end of follow-up there was no new onset hypertension. The demonstrated effectiveness, small number of complications at short-term, not any poorly effect on renal function and blood pressure at the long-term follow-up confirm that PCNL is not only effective but is also safe in the solitary kidney with staghorn calculi.     

Laparoscopic renal biopsy in bilateral pelvic kidney with chronic glomerulonephritis

Percutaneous needle biopsy under the guidance of ultrasound or computerized tomography is the most valuable method in the diagnosis of parenchymal kidney diseases. However, sometimes it can be difficult to perform in the presence of certain anomalies, anatomic variations, or medical problems. In the presence of bilateral pelvic kidney, which is a rare anomaly, laparoscopy can be used to obtain biopsy. Biopsy of kidney was planned in a 26-year-old woman who presented with a history of hypertension for 7 years and proteinuria with the diagnosis of nephrotic syndrome. For the biopsy, the laparoscopic approach was chosen since the patient had bilateral pelvic kidneys. Under general anesthesia, using three port sites, the right kidney was reached, which was located more anterior than the left one. Three biopsy specimens for histologic evaluation were taken with a Tru-Cut biopsy needle. No complications were encountered during or after the operation. The patient was ceased from urological follow-up after performing an ultrasound on the first postoperative day. This is the first case of pelvic kidney with chronic glomerulonephritis reported in the literature in which the histologic diagnosis was made with the help of laparoscopy. Laparoscopic kidney biopsy is a minimally invasive technique that can be done in cases with anatomic variations, making percutaneous needle biopsy impossible.     

Retroperitoneoscopic pyelolithotomy via a posterior approach for large impacted renal pelvic stone

Retroperitoneal laparoscopic pyelolithotomy via a posterior approach was successful in a patient with a large impacted renal pelvic stone. This procedure is beneficial as an alternative to open surgery for stones that cannot be treated by SWL or intracorporeal lithotripsy. This procedure may also be the initial treatment in selected cases.     

Robotic extended pyelolithotomy for treatment of renal calculi: a feasibility study

Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for staghorn renal calculi. Many reports suggest that laparoscopy can be an alternative treatment for large renal stones. We wished to evaluate the role and feasibility of laparoscopic extended pyelolithotomy (REP) for treatment of staghorn calculi. Thirteen patients underwent REP for treatment of staghorn calculi over a 12-day period. Twelve patients had partial staghorn stones and one had a complete staghorn stone. All patients had pre-operative and post-operative imaging including KUB and computed tomography. All procedures were completed robotically without conversion to laparoscopy or open surgery. Mean operative time was 158 min and mean robotic console time was 108 min. Complete stone removal was accomplished in all patients except the one with a complete staghorn calculus. Estimated blood loss was 100 cc, and no patient required post-operative transfusion. REP is an effective treatment alternative to PCNL in some patients with staghorn calculi. However, patients with complete staghorn stones are not suitable candidates for this particular technique.     

Repeated subselective renal embolization following pyelolithotomy: angiographic salvage of a kidney

A bleeding intrarenal aneurysm secondary to pyelolithotomy was treated successfully by super-selective catheterization of the feeding arteries and embolization using stainless steel Gianturco coils. Three therapeutic procedures were performed because of recurrent hemorrhage. The advantages of this mode of treatment are that it is well tolerated, relatively safe and allows maximal preservation of functioning renal tissue.     

肾盏憩室及其并发症的外科处理

目的 探讨肾盏憩室合并结石、感染的诊治特点及方法.方法肾盏憩室患者29例.男11例,女18例.平均年龄26(18～61)岁.其中单纯性肾盏憩室3例,合并感染14例(其中3例外院以肾囊肿行去顶减压术后漏尿转入),合并结石12例.行开放手术治疗10例,憩室去顶,并缝合憩室开口;行腹腔镜下手术8例,憩室处理同开放手术,2例合并结石者同时行取石术;行经皮肾镜取石术(PCNL)11例,取出结石并扩张憩室盏颈,留置肾造瘘管,其中1例中转开放.结果开放及腹腔镜下手术均取得成功,腹腔镜术后1例漏尿予患侧放置双J管1个月后治愈;1例行PCNL术失败中转开放.取石术后1周复查KUB平片无结石残留.29例平均随访14(6～24)个月,患者症状明显改善,无再发感染及结石.结论肾盏憩室常合并结石及感染,采用腹腔镜及PCNL等手术治疗安全可行,疗效确切.术前确诊、术前准备及术中证实是确保手术成功的重要环节.

Abstract：

Objective To analyze the diagnosis and treatment for complications of renal caliceal diverticulum with calculi or infection. Methods A retrospective investigation was performed on 29 cases with renal caliceal diverticulum. The 29 cases included 11 males and 18 females aged 18 to 61 years. Among the study group, 3 cases were simple renal caliceal diverticulum, 12 cases were diagnosed as diverticular calculi and 14 cases presented recurrent urinary tract infections including 3 cases with urinary fistula after unroofing and decompression as renal simple cyst from another hospital. Ten cases underwent an open operation that unroofed and decompressed the cyst, and sutured the diverticular neck. Eight cases underwent laparoscopic operation similar to the open operation, including lithotomy in caliceal diverticulum in 2 cases. Eleven cases diagnosed with caliceal diverticular calculi were taken one-stage percutaneous nephrolithotomy including dilating the diverticular neck, remaining the nephrostomy catheter and Double-J ureteral stents, and 1 case was transferred to open operation.Results The open and laparoscopic operations were performed successfully. One case was cured by Double-J ureteral stenting after postoperative urinary leakage. One case was transferred to open operation for the failure of percutaneous puncturation. X-ray examination revealed that there were no remaining stones after the operation. All the patients were followed up for 6 to 24 months without calculi and infection recurrence. Conclusions Stones and infection are common that complications of renal caliceal diverticulum. Percutaneous nephrolithotomy, laparoscopy and other operations were effective and feasible treatment options for cases with complications of renal caliceal diverticulum. Exact diagnosis was very important for treatment of renal caliceal diverticulum before operation.