肾盏憩室误诊为肾囊肿导致术后漏尿的防治探讨(附8例报道)

Investigation on the therapeutic and prevention measures for urinary leakage after operation for renal caliceal diverticula misdiagnosed as renal cyst

目的探讨肾盏憩室去顶术后漏尿的治疗方法及预防措施。方法选择2003年至2013年我院收治的8例术后漏尿的患者,术前均误诊为肾囊肿,术后证实为肾盏憩室。在逆行插入D-J管的基础上,1例漏尿自然愈合;7例行手术治疗,其中1例采取微创顺行切开扩大憩室颈的方法,4例行开放手术,2例行腹腔镜手术,术中缝合憩室颈开口,灼烧憩室腔黏膜。结果所有患者漏尿均愈合,患者无发热,无腰痛,B超显示患肾周围无积液,其中6例憩室完全消失,2例可见憩室较术前明显减小。结论肾盏憩室行去顶减压后出现的漏尿不易自行愈合,应采用手术治疗,预后较好。而术前正确诊断肾盏憩室是减少术后漏尿的关键。

Objective To investigate the therapeutic and prevention measures for urinary leakage after decortication for caliceal diverticula. Methods The clinical data of 8 caliceal diverticula patients suffered from urinary leakage after operation were analyzed. All patients were misdiagnosed as renal cyst preoperatively. After the the double-J stent were inserted, urinary leakage was naturally healed in 1 patient, but surgical operation were taken in the other 7 patients, including 1 case of microinvasive antegrade surgery, 4 cases of open surgical operation and 2 cases of laparoscopic operation. In the microinvasive antegrade surgery, a patent diverticular neck was dilated by percutaneous tract, then a D-J stent was placed through the cannel into renal pelvis. In the open and laparoscopic operation, a diverticular neck was closed with suturing, and the wall of diverticular cavity was fulgurated by electrocautery. Results Urinary leakage was healed in all patients. Fever and lateral pain was not found, and no liquid mass around kidney was demonstrated in ultrasound examination. The cavity of caliceal diverticula was disappeared in 6 patients accepted surgical operation and the cavity was smaller in 2 others patients. Conclusion Urinary leakage after decortication for caliceal diverticula is not easy to heal spontanepusly. Surgical operation should be done. The prognosis is generally good, but correct diagnosis for caliceal diverticula is the key of prevention of urinary leakage.