微创外科治疗合并临床症状的肾盏憩室结石

Minimally invasive surgical procedures treating symptomatic caliceal diverticular calculi

目的 探讨合并临床症状的肾盏憩室结石的微创治疗方法及安全性.方法 合并临床症状的肾盏憩室结石患者21例.男9例,女12例.平均年龄39（22～57）岁.憩室平均直径3.7（2.5～7.0）cm,结石平均直径为2.3（0.8～3.5）cm.患者临床表现为血尿、腰痛、泌尿系感染.均经影像学检查诊断,分别采用逆行输尿管软镜碎石4例、PCNL 7例、腹腔镜下手术取石9例、腹腔镜联合PCNL取石1例.结果 21例手术顺利,无中转开放手术、穿孔、周围脏器损伤等并发症.术后1周出现医源性动静脉瘘合并迟发性出血1例,2 d后自发形成血栓治愈;结石残留但临床症状明显缓解2例.19例无残留结石随访6～12个月结石无复发.结果 有效地选择适应证和建立合理治疗方案的前提下,微创外科治疗合并临床症状的肾盏憩室结石安全有效.

Objective To investigate the approach and safety of minimally invasive surgical procedures treating symptomatic caliceal diverticular calculi. Methods Clinical data of 21 cases with symptomatic caliceal diverticular calculi were retrospectively reviewed. Twelve females and 9 males aged 22 to 57 years old. The average diameter of caliceal diverticulum was 3.7 cm （2.5-7.0 cm） and average diameter of calculi was 2.3 cm （0.8-3.5 cm）. The patients underwent flexible ureteroscopic lithotripsy, PCNL or mPCNL, laparoscopic techniques and laparoscopy-assisted transperitoneal PCNL, respectively. Four cases underwent flexible ureteroscopic lithotripsy. PCNL （2 cases） or mPCNL（5 cases）were performed in 7 cases. Nine cases underwent laparoscopic techniques. Laparoscopyassisted transperitoneal PCNL was performed in 1 case. Results The operations were performed successfully in 21 cases. No case need to transfer to open surgery during the operation and no major complications like perforation or organic injury were noted. One case with iatrogenic arteriovenous fistula of the kidney after 1 week postoperative was cured by delayed hemorrhage 2 days later, while clinical symptoms of 2 cases with residue calculi relieved. 19 cases without residue calculi were followed up for 6 to 12 month without recurrence. Conclusions After handling indication of treatment efficiently and creating advisable therapeutic decision-making, minimally invasive surgical procedures treating symptomatic caliceal diverticular calculi appears to be effective and safe.