经皮肾镜碎石术治疗症状性肾盏憩室结石11例报告

Percutaneous Nephrolithotripsy for the Symptomatic Caliceal Diverticular Calculi(Report of 11 Cases)

目的:探讨经皮肾镜碎石术治疗肾盏憩室结石的安全性及有效性。方法:回顾性分析11例接受经皮肾镜碎石治疗肾盏憩室结石患者的临床资料:采用标准通道经皮肾镜术4例,微通道肾镜术7例。10例行Ⅰ期直接穿刺憩室碎石术,1例因通道出血改为Ⅱ期碎石。6例术中用自制电钩切开肾盏憩室颈口。结果:手术时间平均为(1.83±0.49)h,结石直径平均为(1.73±0.71)cm,2例中盏憩室结石取净,术后未留置D-J管,1例中盏憩室结石术后完全无管化。术后复查KUB平片,9例取净,2例残留,结石直径均小于4 mm,未行碎石,结石清除率为81.8%,无并发症发生。随访3个月～1年,8例症状缓解,3例减轻。结论:经皮肾镜碎石术治疗症状性肾盏憩室结石安全可行,可做为选择性治疗方法。

Objective：To investigate the safety and efficacy of percutaneous nephrolithotripsy for the treatment of caliceal diverticular calculi. Methods：Clinical data of eleven patients who underwent PCNL or MPCNL for cal- iceal diverticular calculi from 2005 to 2009 were reviewed retrospectively. PCNL for 4 cases and MPCNL for 7 ca- ses. The percutaneous renal access to diverticulum was established and phase I lithotripsy was performed in 10 pa- tients,phase II lithotripsy in 1 patient due to the bleeding during the operation. The diverticular neck was incised by the electrode in six patients. Results= Mean operative time was（1.83fi：0. 49）h and mean stone diameter was （1.73-/-0. 71 ）cm. 2 patients with interpolar caliceal diverticular calculi were stone-free without the need of ureteral stento white totally tubeless in one patient. Of 11 cases, stone free rate was 81.8~ （9/11）. Residual stone frag- ment was found in 2 cases by postoperative KUB without any treatment. No severe complications occurred. The symptoms were released in 8 cases and lessened in 3 cases during the follow-up. Conlusions PCNL was a safe and efficient method for the treatment of the symptomatic caliceal diverticular calculi in the selected cases.