经皮肾镜超声碎石取石联合盏颈切开一期治疗肾盏憩室结石22例

Percutaneous ultrasonic nephrolithotomy combined with calyceal diverticulum light neck cutting for treatment of calyceaI diverticular calculi ： Report of 22 Cases

目的 评价经皮肾镜超声碎石取石联合盏颈切开一期治疗肾盏憩室结石的临床有效性与安全性.方法 回顾性分析2010年7月～ 2013年7月施行的22例经皮肾镜超声碎石取石联合盏颈切开一期治疗肾盏憩室结石患者的临床资料.采用B超定位穿刺结石所在的肾盏憩室,应用气压弹道超声击碎结石并取出,同时在美蓝引导下以柱状电极切开狭窄的憩室颈部.术后常规留置肾造瘘管及输尿管支架管引流.术后4周拔除肾造瘘管,3个月后膀胱镜下拔除内支架管.结果 21例行Ⅰ期直接穿刺憩室碎石术,1例因穿刺失败通道出血改为Ⅱ期碎石.术后复查无结石残留,双J管位置良好.手术时间40～ 110min,平均73±24min,术中出血量为60～220ml,平均出血量80mL.术后平均住院时间7d,随访3～24个月,均未发现肾盏憩室内结石再发.结论 经皮肾镜超声碎石取石联合盏颈切开一期治疗肾盏憩室结石安全有效,清石率高,创伤小及并发症少.

Objectives To evaluate the clinical efficacy and safety of percutaneous ultrasonic nephrolithotripsy combined with calyceal diverticulum light neck cutting in the treatment of calyceal diverticular calculi.Methods From Jul 2010 to Jul 2013,the clinical data were analysed 22patients of calyceal divenicular calculi who underwent the percutaneous ultrasonic nephrolithotripsy.Under the guidance Of B-ultrasonogmphy,we penetrated directly into the corresponding diverticulum,with the application of pneumatic lithotripsy and ultrasound fragmented calculi and remove.Under the guidance of the Methylene Blue,the neck of the diverticulum were cut with the help columnar electrodes.After the procedure,trans-diverticular pereutaneous drainage was maintained for 4 weeks,and trans-diverticular ureteral stent was removed 3 months after the operations.Results The percutaneous renal a -ccess to diverticulum was established and phase Ⅰ lithotripsy was performed in 12 patients,phase Ⅱ lithotripsy in 1 patient due to the bleeding during the operation.No residual calculi was observed after the operation and the double J stents was in good position.The whole duration of the operation was 40 ～ 110 minutes with an average of 73 ±-24 minutes,and the blood loss was 60 to 200 ml and 80 ml in average.The average hospital stay was 7 days.All of patients had no recurrence of diverticular calculi during the follow up（ranged 3-6month）.Conclusions Percutaneous ultrasonic nephrolithotripsy combined with calyceal diverticulum light neck cutting is safe and effective for calyceal diverticular calculi with a high stone-free rate,and low incidence rate of intraoperative and postoperative complications.