酷似肾囊肿的肾盏憩室7例临床分析

目的 提高对临床表现酷似肾囊肿的肾盏憩室的认识,探讨其诊治方法.方法 报告7例经本院收治的肾盏憩室患者的临床资料,回顾性分析其临床特征及影像学表现.7例患者以腰部胀痛为主要表现者2例,5例无明显症状.术前超声检查均诊断为肾脏囊肿,2例患者静脉肾盂造影检查怀疑肾盏憩室,5例行增强CT并延迟扫描后确诊为肾盏憩室.分析所有患者临床资料并检索Pubmed和CBM数据库,对该疾病相关文献进行复习.结果 1例患者行保守治疗,1例按单纯囊肿行去顶手术后出现漏尿,后行肾部分切除术.5例成功行腹腔镜肾盏憩室切除术,术前放置输尿管导管并于术中通过导管注射美蓝帮助确定憩室开口.术后随访6～24个月,未发现憩室复发.结论 肾盏憩室临床上少见,容易误诊.静脉肾盂造影及增强CT扫描对诊断该病有较大帮助,特别是CT延迟扫描.腹腔镜肾盏憩室切除术治疗该病安全有效.

Clinical diagnosis and treatment of renal calyceal diverticulum

Objective To explore the diagnosis and treatment of renal calyceal diverticulum.Methods Clinical data of 7 cases of renal calyceal diverticulum were reported,and the clinical characteristics and image findings were retrospectively analyzed.Of the 7 patients,2 presented distending pain on the waist and the other 5 presented no specific clinical manifestations.All cases were diagnosed as renal cyst with ultrasonography before surgery.2 cases underwent intravenous pyelography and were suspected as renal calyceal diverticulum.5 cases received CT delayed sweep and were diagnosed as renal calyceal diverticulum before surgery.The related literature was searched in Pubmed and CBM databases and clinical data were reviewed.Results 1 patient received expectant treatment,1 underwent renal cyst unroofing and leakage of urine after surgery and then partial nephrectomy.The other 5 patients underwent laparoscopic calyceal diverticula excision successfully.The ureteral catheter was inserted at the beginning of the surgery and methylene blue was used throughout the surgery to locate the diverticula open.During the follow-up of 6 to 24 months,no diverticula recurrence was detected.Conclusions Renal calyceal diverticulum is a rare disease,which is easily misdiagnosed.Intravenous pyelography and CT scan,especially CT delayed sweep can help the accurate diagnosis while retroperitoneoscopic surgery is safe and effective to treat this disease.