微创经皮肾镜铥激光碎石术治疗肾盏憩室结石疗效及安全性分析

Analysis of the therapeutic effect of simultaneously thulium laser with minimally invasive percutaneous nephrolithotomy in the management of caliceal diverticular calculi

目的总结微创经皮肾镜（MPCNL）铥激光碎石术治疗肾盏憩室结石的疗效与安全性。方法回顾性分析我院2011年2月至2015年1月接受MPCNL铥激光碎石术治疗的39例肾盏憩室结石患者临床资料,总结肾盏憩室结石的微创治疗经验。本组患者男18例,女21例;年龄35~67岁,平均48.6岁。其中单纯肾盏憩室结石14例,肾结石或输尿管上段结石合并肾盏憩室结石25例。单纯肾盏憩室结石采用B超引导下穿刺憩室或结石,采用铥激光先碎石,再切开憩室颈部;肾盏憩室结石合并肾、输尿管结石患者,先在B超引导下穿刺肾中盏或上盏,铥激光处理肾、输尿管上段结石,如能发现憩室颈口,则切开颈口并处理结石,如不能发现憩室颈口,则重新穿刺憩室,其中3例患者发现憩室颈口,22例患者重新穿刺肾盏憩室碎石。结果 39例患者均一期碎石成功,无术中、术后严重并发症发生。术后复查泌尿系B超,均无结石残留。随访6~24个月,均未发现憩室内结石复发。结论 MPCNL铥激光碎石术治疗肾盏憩室结石具有清石率高、憩室盏颈处理彻底的优点,值得推广应用。

Objective To evaluate the clinical efficacy and safety of thulium laser combined with minimally invasive percutaneous nephrolithotomy（MPCNL）in the management of caliceal diverticular calculi.Methods Clinical data of 39（18male,21 female,aged 35-67 years,average 48.6 years）cases of renal caliceal diverticular calculi treated with thulium laser combined with MPCNL during Feb.2011 and Jan.2015 were retrospectively reviewed.Stones were removed intact or fragmented in all patients,and the diverticular necks were incised with thulium laser.Results All operations were successful.No serious complications occurred during and after the operations.The average hospital stay ranged 7 to 10 days and the time of nephrostomy tube indwelling was 2 weeks.After the operation,CT scan showed no residual stones.During the average followup of 6 to 24 months,no recurrence was observed.Conclusions Thulium laser combined with minimally invasive percutaneous nephrolithotomy can safely and effectively treat caliceal diverticular calculi.