针状可视肾镜治疗肾盏憩室结石(附36例报告)

Treatment of Caliceal Diverticular Calculi With Needle-like Visual Nephroscope:a Report of 36 Cases

目的探讨超声引导下针状可视肾镜联合钬激光处理直径1.0~2.5 cm肾盏憩室结石的临床疗效。方法全身麻醉成功后输尿管镜下在患侧放置F5输尿管导管,并留置F18三腔尿管固定。改行俯卧位,在超声引导、显示器直视下,针状可视肾镜进入目标盏,留置硬导丝,应用扩张套件从F8逐号扩张至F14,连接F8可视肾镜碎石清石系统,550μm钬激光光纤将结石粉碎并吸出。若憩室盏颈口难以寻及,沿输尿管导管逆行推注10%亚甲蓝,找到盏颈口后用钬激光将盏颈口切开,顺行置入F6输尿管支架管。结果36例均一次碎石取石成功。手术时间33~65 min,平均47.5 min。术后血红蛋白下降0.6~1.9 g/L,平均1.35 g/L。1例术中第1天出现发热,体温38.5℃,积极抗感染后体温恢复正常。6例术后出现肉眼血尿,尿管引流液呈暗红色,给予对症止血、卧床及膀胱冲洗后血尿逐渐停止,均无需输血。术后住院4~6 d,平均5.2 d。术后6、12个月复查肾脏CT,36例肾脏结石无复发,清石率100.0%(36/36)。结论针状可视肾镜治疗肾盏憩室结石安全、有效。

Objective To investigate the clinical effect of ultrasound-guided needle-like visual nephroscope combined with holmium laser in the treatment of 1.0-2.5 cm diameter caliceal diverticular calculi.Methods After successful anesthesia,the ureteroscope was used to place the F5 ureteral catheter on the affected side,and the F18 three chamber catheter was retained for fixation.Then the patients were changed to the prone position.Under the guidance of ultrasound and the direct view of the display,the needle-like visual nephroscope was entered the target calices,and the hard guide wire was retained.The calyx was expanded from F8 to F14 one by one with the expansion kit.Then the F8 visual nephroscope lithotripsy and stone clearing system was connected.The 550μm holmium laser fiber was used to crush and suck out the stones.If it was difficult to find the calyceal neck of diverticulum,10%methylene blue was retrogradely injected along the ureteral catheter.After the calyceal neck was found,the calyceal neck was cut open with holmium laser,and the F6 ureteral stent was placed along the way.Results All 36 cases were treated successfully at one session.The operation time was 33-65 min(mean,47.5 min).Postoperative hemoglobin decreased by 0.6-1.9 g/L(mean,1.35 g/L).One patient had fever on the first day after operation,with a temperature of 38.5℃,and the temperature returned to normal after active anti-infection therapy.In 6 cases,hematuria occurred with naked eyes and the drainage fluid of urinary tube was dark red.Hematuria stopped gradually after hemostasis,bed rest and bladder washing.No blood transfusion was needed.The postoperative hospitalization time was 4-6 d(mean,5.2 d).The renal CT was re-examined 6 and 12 months after operation.There were no caliceal diverticular calculi in the 36 cases.The stone removal rate was 100.0%(36/36).Conclusion It is safe and effective to treat caliceal diverticular calculi with needle-like visual nephroscope.