飞行员肾盏憩室结石4例诊断治疗并文献复习

Diagnosis,treatment and medical evaluation of four cases of calyceal diverticulum stones in pilots and literature review

目的探讨飞行员肾盏憩室结石诊断治疗方法及飞行医学鉴定标准。方法回顾分析2014年9月—2020年7月空军特色医学中心收治的4例飞行员肾盏憩室结石患者病例资料并复习相关文献。结果4例患者均因常规体检发现右肾结石入院,结石长径分别为5.8、8、7 mm和7 mm。4例患者均接受输尿管软镜检查术,其中1例单座机飞行员软镜下结石取净,鉴定飞行合格;1例单座机飞行员术中发现肾盏憩室开口狭小,考虑结石不能排出,特许飞行合格;1例患者术中未能发现肾盏憩室开口,限原机种(双座机)飞行合格;1例民航飞行学员软镜下未能发现肾盏憩室开口,改行经皮肾镜取石术,结石治愈。结论影像学检查结合微创腔镜技术是诊疗肾盏憩室结石的有效方法,可以帮助飞行员重返飞行岗位;应尽快制定肾盏憩室结石的特许飞行医学鉴定标准。

Objective To explore ways of diagnosis and treatment of calyceal diverticulum stones in pilots and the criteria for flight medical identification.Methods The clinical data of four pilots with renal diverticulum stones treated in Air Force Medical Center between September 2014 and July 2020 was retrospectively analyzed,and the related literature was reviewed.Results All the four patients were admitted to the hospital due to right kidney stones detected in routine physical examinations,the diameter of the stones was 5.8 mm,8 mm,7 mm and 7 mm respectively.Flexible ureteroscopy was performed on these patients.Among them,a single-seat fighter pilot had his calculi removed under f lexible ureteroscopy and was identified as qualified for flight.A second single-seat fighter pilot was found to have narrow opening of the renal diverticulum intraoperatively,who was permitted to fly considering that the stone could not be discharged.Due to the failure to find the opening of the calyceal diverticulum intraoperatively,one two-seat aircraft pilot was considered qualified to fly the original type of aircraft.The trainee pilot from civil aviation whose opening of the calyceal diverticulum had not been found underwent flexible ureteroscopy,so percutaneous nephrolithotomy was performed to remove the stones.Conclusion Imaging examination combined with minimally invasive endoscopic techniques are effective in the diagnosis and treatment of calyceal diverticulum stones,which can help pilots return to flight.The waiver criteria for medical identification of calyceal diverticulum stones should be developed as soon as possible.