经皮肾镜取石联合肾盏颈切开术治疗肾盏憩室结石的疗效分析

目的探讨经皮肾镜取石联合钬激光肾盏憩室颈切开术治疗肾盏憩室结石的安全性及有效性。方法回顾性分析2010年3月至2016年3月本院泌尿外科收治的21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,碎石取石后并以钬激光切开憩室颈口,术后留置肾造屡管及双J管。结果21例患者均采用一期单通道碎石,并切开肾盏颈口。手术时间为35~112(50.0±16.3)min;术中出血30~250(52.0±2.3)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90.5%(19/21),随访3~12个月,所有患者憩室消失或变小。结论经皮肾镜取石联合肾盏颈切开术治疗肾盏憩室结石创伤小、并发症少,效果确切。

Clinical effect of percutaneous nephrolithotripsy combined with calyceal diverticular neck incision for treatment of calyceal diverticular calculi

Objective To evaluate the safety and efficiency of percutaneous nephrolithotripsy(PCNL)combined with calyceal diverticular neck incision in the treatment of calyceal diverticular calculi.Methods The clinical data of 21 patients of calyceal diverticular calcali treated by PCNL combined with calyceal diverticular neck incision were retrospectively analyzed from March 2010 to March 2016.The corresponding diverticulum was penetrated under the guidance of B type ultrasonography.Stones were removed intact or fragmented with holmium laser lithotripsy by PCNL,and the diverticular necks were incised with holmium laser and placed with a 16 F nephrostomy tube and Double-J tube for several days.Results All operations were successful with no transfusion and conversion to open.The mean operation time was 35-112 min,average(50.0±16.3)min,the operation bleeding was 30-250 mL,average(52.0±2.3)mL.No severe complications occurred in all patients such as massive hemorrhage or adjacent organ damage,and no patient was transferred to open surgery during the operation.The total stone clearance rate was 95.2%(19/21).Postoperative CTU showed obliteration of diverticula or impeded drainage in all cases during the follow-up of 3 to 12 months.Conclusions PCNL combined with calyceal diverticular neck incision is an effective and feasible treatment option with less invasion and low incidence of complications.