微创经皮肾镜取石术治疗肾盏憩室结石(附24例报道)

Minimally Invasive Percutaneous Nephrolithotomy for Calyceal Diverticular Calculi:Report of 24 Cases

目的评估微创经皮肾镜取石术（minimally invasive percutaneous nephrolithotomy,MPCNL）治疗肾盏憩室结石的临床有效性与安全性。方法 2005年2月~2008年10月,应用MPCNL治疗24例肾盏憩室结石。术中B超引导下穿刺肾盏憩室,采用Wolf F8/9.8输尿管镜,气压弹道探针或钬激光击碎结石后取出,钬激光烧灼开放肾盏流出道,术后常规留置肾造瘘管及内支架管引流。术后7天拔除肾造瘘管,3个月后膀胱镜下拔除内支架管。结果 24例均一次碎石取石成功。手术时间55~110 min,（65.5±28.1）min。1例术中发现肾盏憩室感染积脓,术后发热38.5℃以上,积极抗感染,4 d后体温恢复正常。其余病例未见明显并发症。术后3 d血红蛋白下降0.09~1.85 g/L（中位数0.15 g/L）。术后住院4～8 d,（5.7±2.5）d。24例随访18～36个月,（22.6±7.1）月,均未发现肾盏憩室内结石再发。结论 MPCNL治疗肾盏憩室结石安全有效,碎石效率高,并发症少。

Objective To assess the safety,feasibility and the curative effect of minimally invasive percutaneous nephrolithotomy（MPCNL） for calyceal diverticular calculi. Methods A retrospective investigation was carried out in 24 cases of calyceal diverticular calculi,who were treated with MPCNL from February 2005 to October 2008 in our hospital.Under the guidance of B-ultrasonography,we performed percutaneous nephrolithotomy by using Wolf F8/9.8 ureteroscope,diverticular infundibulum,and Holium laser.After the procedure,trans-diverticular percutaneous drainage was maintained for 7 days,and trans-diverticular ureteral stent was removed 3 months after the operations. Results 100% stone-free rate was achieved in all the patients by one-stage MPCNL.The average operation time and hospital stay were（65.5±28.1） minutes（ranged 55-110 minutes） and（5.7±2.5） days（ranged 4-8 days）,respectively.During the surgery,infectious diverticulum was found in on patient,who developed postoperative hyperpyrexia（38.5 ℃） and then recovered after antibiotics therapy in 4 days.No other complications were noted in the patients.On the third day after the operation,the mean reduction of blood hemoglobin concentration was（0.09-1.85） g/L（median 0.15 g/L）.All of patients had no recurrence of diverticular calculi during a mean of（22.6±7.1） months follow-up（ranged 18-36 months）.Conclusions MPCNL is safe and effective for calyceal diverticula calculi with a high stone-free rate,short hospitalization stay,and low incidence rate of intraoperative and postoperative complications.