微创经皮肾镜取石术治疗肾盏憩室结石  

Minimally invasive percutaneous nephrolithotomy for calyceal diverticular calculi

作　　者：李明果[1] 林芝[1] 李成山[1] 罗继毅[1] 唐东林[1] 刘敏[1] 

机构地区：[1]广西百色市人民医院泌尿外科,533000

出　　处：《临床外科杂志》2013年第7期545-546,共2页Journal of Clinical Surgery

摘　　要：目的探讨微创经皮肾镜取石术治疗肾盏憩室结石的有效性与安全性。方法应用微创经皮肾镜治疗21例肾盏憩室结石。术中B超引导下穿刺肾盏憩室，采用Wolf F8／9．8输尿管镜，气压弹道探针击碎结石后取出，F3球囊扩张导管扩张肾盏憩室流出道，术后常规留置肾造瘘管及F7双J管。术后7d拔除肾造瘘管，6～8周后膀胱镜下拔除双J管。结果21例均一次碎石取石成功，手术时间55～110min，平均（70±5）min，出血量约50～280ml，平均（145±25）ml，术后住院时间6～9d，平均（7±2）d。1例术中出现胸膜损伤，经胸膜腔穿刺抽气抽液后治愈；3例术后发热39．O℃以上，积极抗感染，4～5d后体温恢复正常。无术中术后大出血，无输血病例。21例随访6—18个月，均未发现肾盏憩室内结石再发。结论微创经皮肾镜治疗肾盏憩窒结石安全、有效，损伤小，恢复快，值得临床推广应用。Objective To investigate the safety and efficacy of minimally invasive percutaneous nephrolithotomy for the treatment of caliceal diverticular calculi. Methods The clinical data of 21 patients who underwent MPCNL for caliceal divertieular calculi from October 2006 to December 2011 were reviewed retrospectively. Under the guidance of type-B ultrasonogmphy, the amniocentesis and pneumatic lithotripsy for calyceal diverticular calculi were performed by using Wolf F8/9.8 ureteroscope. The F3 balloon dilatation catheter was used to expand the outflow tract of calyceal diverticulum. After the procedure,the nepbrostomy tube was placed and maintained for 7 days and the double-J tube was placed and removed 6 - 8 weeks later. Results The 100% stone-free rate was achieved in all the patients by one-stage MPCNL. The average operation time were 70±5 minutes （ range 45 - 115 minutes ） and hospital stay were 7 ± 2 days （ range 6 - 9 days）respectively. During the surgery, 1 cases had pleura injury and was cured after the thoracentesis and suction,3 cases developed postoperative hyperpyrexia（ above 39. 0~3 ）and then recovered after antibiotic therapy in 4-5 days. No massive hemorrhage and blood transfusion occurred during all operations. All patients had no recurrence of diverticular calculi during the follow-up period of 6 - 18 months. Conclusion MPCNL is safe and effective for calyceal diverticula calculi with few trauma and quick recover ,which is worthwhile to be widely used.

关 键 词：微创经皮肾镜 肾盏憩室 泌尿系结石 

分 类 号：R692.4[医药卫生—泌尿科学]