输尿管软镜钬激光碎石术治疗合并临床症状的肾盏憩室结石

Flexible ureterorenoscopy with holmium laser lithotripsy in management of symptomatic caliceal di- verticular calculi

目的探讨输尿管软镜钬激光碎石术治疗合并临床症状的肾盏憩室结石的安全性及有效性。方法回顾性分析2008年1月至2010年12月输尿管软镜钬激光碎石术治疗23例合并临床症状的肾盏憩室结石患者资料。男15例，女8例。年龄23—68岁，平均44岁。主要特点为腰痛、血尿，尿路感染。10例曾行ESWL治疗，其中1例曾行2次ESWL。23例均为单侧肾盏憩室结石，结石位于肾上极11例，中部9例，下极3例。成堆泥沙样多发结石19例，单发结石4例。结石最大直径18．9mm。术前1周均留置双J管，均行IVU及双肾cT检查。静脉复合麻醉下行输尿管软镜钬激光碎石术，留置输尿管扩张鞘，置入输尿管软镜抵达肾盂，寻及憩室开口，必要时用钬激光切开憩室颈部，憩室内大部分结石呈泥沙样聚集，小部分结石较大，予以钬激光碎石，结石碎屑随灌洗液冲出或用套石篮取出。结果本组23例均顺利置入输尿管软镜，一次进镜成功率100％。22例顺利寻及憩室结石，1例术中未寻及憩室开口改行PCNL，手术顺利。碎石成功20例（87．0％），术后无结石残留15例（65．3％）。残留结石〈4mm者5例；3例碎石失败者结石残块≥4mm。平均手术时间60min，术后平均住院日3．5d。手术无并发症发生。术后随访6～12个月，患者症状均消失，未见结石复发。结论输尿管软镜钬激光碎石术治疗合并临床症状的肾盏憩室结石安全、有效，可作为临床首选治疗方法。

Objective To evaluate the therapeutic effect of flexible ureterorenoscopy （F-URS） with holmium laser lithotripsy in managing symptomatic caliceal diverticular calculi. Methods The records of 23 patients by flexible ureterorenoseopy （F-URS） with holmium laser lithotripsy in managing symptomatic calieeal diverticular calculi from January 2008 to December 2010 were retrospectively reviewed. The 23 cases included 15 males and 8 females, aged from 23 to 68 years. All patients had unilateral calyceal diverticulum stone, with 11, 9, and 3 eases had a caliceal divertieular stone in the upper pole, midkidney, and lower pole, respectively. Sand-like stones were observed in most caliceal divertieular. The diameter of the largest stone was 18.9 mm. The presenting symptoms were flank pain, recurrent urinary tract infections, and hematuria. One week before operations, all patients was placed Double-J stent and underwent intravenous urography and renal computed tomography （CT）. The ureteral access sheath was placed firstly during operation, and then ureterorenoscope was inserted into the renal pelvis. The diverticular neck was incised with holmium laser if needed, and a 200urn holmium laser fiber was used to crush diverticular stone. Results Flexible ureterorenoscopes were successfully placed in all patients. Postoperatively, 15 （65.3%） patients were rendered stone free （SF）, 5 patients had clinically insigni？ cant residual fragments （less than 4 mm） （CIRF） , and a residual fragment （RF） was found in three patients. The success rate （ SF ＋ CIRF） was 87. 0%. All patients were symptom free after operation. The average operative time and hospital stay were 60 minutes and 3.5 days, respectively. No severe complications occured. A follow-up of 6 - 12 months showed no recurrence. Conclusions F-URS using a holmium laser lithotripsy is a safe and effective, and may be offered as a first line therapy for symptomatic caliceal diverticula calculi.