肾盏憩室结石的诊疗进展

Diagnosis and Treatment of Caliceal Diverticular Calculi

肾盏憩室是无分泌功能的尿路上皮内衬的肾内囊性空腔,常伴有结石形成,憩室中结石的成因是代谢因素和尿流停滞的共同作用结果。其确诊则需静脉尿路造影、肾CT(平扫+强化)、逆行肾盂造影。肾盏憩室无症状时不需要治疗,但憩室直径大或合并结石时需要手术治疗。体外冲击波碎石和开放手术是既往常用的治疗手段,经皮肾镜手术及内镜途径是目前常用治疗方法,腹腔镜及机器人是新兴的治疗选择及替代方案。目前,当肾解剖存在异常时,推荐使用内镜和腹腔镜治疗。用机器人辅助腹腔镜来治疗肾盏憩室结石是安全可行的,它可以同时处理结石及憩室。

A caliceal diverticulum is a cystic intrarenal cavity lined by nonsecretory urothelium, which is often accom-panied by the formation of stones, the causes of calculi in the diverticulum is the combined effect of the results of metabolicfactors and urinary stagnation. The diagnosis requires intravenous urography,renal CT （plain ＋ enhanced） ,retrograde pye-lography. Asymptomatic ealieeal diverticulum does not need treatment,but the large diverticulum diameter or being compli-cated with stones need surgical treatment. Extraeorporeal shock wave lithotripsy and open surgery were commonly used treat-ments in the past ; percutaneous nephrolithotomy and endoscopic approach are the commonly used methods currently;lapa-roscopy and robots are emerging treatment options and alternatives. Currently, endoscopic and laparoscopic procedures arerecommended when there is abnormal renal anatomy. Robot-assisted laparoscopic treatment of caliceal diverticular calculi issafe and feasible,which can simultaneously handle stones and diverticula.