针状肾镜联合输尿管软镜治疗复杂性肾盏憩室结石的安全性和疗效  

Clinical study and efficacy evaluation of Needle-perc combined with RIRS in the treatment of complexcalycealdiverticularstone

作　　者：刘宇保 肖博[1] 胡卫国[1] 张刚[1] 付猛[1] 苏博兴[1] 唐宇哲[1] 宋海峰[1] 王碧霄 罗智超 李建兴[1] Liu Yubao;Xiao Bo;Hu Weiguo;Zhang Gang;Fu Meng;Su Boxing;Tang Yuzhe;Song Haifeng;Wang Bixiao;Luo Zhichao;Li Jianxing(Department of Urology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing102218,China)

机构地区：[1]清华大学附属北京清华长庚医院泌尿外科清华大学临床医学院,北京102218

出　　处：《中华泌尿外科杂志》2024年第6期461-466,共6页Chinese Journal of Urology

摘　　要：目的探讨顺行针状肾镜(Needle-perc)联合逆行输尿管软镜(RIRS)技术治疗复杂性肾盏憩室结石的安全性和疗效。方法去回顾性分析北京清华长庚医院2020年1月至2022年12月收治的23例复杂性肾盏憩室结石患者的病例资料,复杂因素主要包括憩室颈口隐匿、结石体积较大、解剖位置特殊等,行单一RIRS或经皮肾镜取石术(PCNL)治疗困难或失败。男14例,女9例。年龄(42.3±6.1)岁。3例为上盏憩室结石,结石大小(0.9±0.2)cm;9例为中盏后组憩室结石,结石大小(1.2±0.3)cm;4例为中盏前组憩室结石,结石大小(1.8±0.2)cm;7例为下盏憩室结石,结石大小(1.3±0.1)cm。12例于外院行RIRS,术中因憩室颈口隐匿或肾盂肾下盏漏斗夹角过小未发现结石或碎石困难;3例行PCNL因通道建立失败终止手术8例于我院首诊。男性患者取斜仰卧截石位、女性患者取俯卧分腿位,采用针状肾镜联合RIRS的顺逆行双镜联合方式治疗。针状肾镜穿刺均在全超声引导下完成,术中通过注射亚甲蓝或双镜互为引导下寻找憩室颈并用钬激光切开扩大出口。根据结石大小和位置分别采用单一针状肾镜下激光碎石联合软镜取石,或双镜下同时使用双激光碎石并取石。记录一期净石率、手术时间、血红蛋白下降值、手术并发症、术后住院时间等。结果本研究23例均一期顺利完成手术。手术时间(61.5±12.2)min。术后血红蛋白下降(3.6±0.4)g/L。术后住院时间(2.8±0.6)d。3例术后发热,1例出现肾被膜下积液,经抗感染、对症治疗后好转出院。未发生输血、腹腔脏器损伤和尿源性脓毒症等Clavien-Dindo≥I级并发症。术后48 h内和1个月的净石率分别为78.2%(18/23)和100.0%(23/23),结论采用顺行针状肾镜联合逆行RIRS技术治疗复杂性肾盏憩室结石安全、可行,可有效提高一期手术成功率,具有净石率高、损伤小、术后并发症少等优势。Objective To retrospectively analyze and summarize the clinical experience and therapeutic effect of anterograde Needle-perc combined with RIRS,namely N+R(Needle perc+RIRS)technique in the treatment of complex calyceal diverticular stone.Methods Retrospective analysis of 23 cases of complex renal caliceal diverticulum stones admitted to our hospital from January 2020 to December 2022.The complex factors mainly include the invisible cervical orifice of diverticulum,large stone volume,and special anatomical location,which makes single RIRS or PCNL treatment difficult or unsuccessful.There were 14 males and 9 females with an average age of(42.3±6.1)years.Three cases were upper calyceal diverticular stone,average size was(0.9±0.2)cm.Nine patients had diverticular stone in the middle posterior calyx,and the average size was(1.2±0.3)cm.The average size of four diverticular stone was(1.8±0.2)cm in the anterior middle calyx.Seven patients had diverticular stone with an average size of(1.3±0.1)cm in lower calyx.Among them,12 patients underwent RIRS which were difficult or stone undiscovered,and 3 patients underwent PCNL and the operation was terminated due to failure of channel establishment.In our center,oblique supine lithotomy position(male)or prone split-leg position(female)was adopted,and the combined treatment of Needle-perc and RIRS was performed.Needle-perc puncture was completed under the guidance of full ultrasound.During the operation,methylene blue reagent or mutual guidance of two endoscopes was used to find the diverticulum neck and expand the outlet with holmium laser incision.Depending on the size and location of the stones,a single Needle-perc laser lithotripsy combined with stone removal in flexible ureteroscope was used,or dual lasers were be used simultaneously for stone removal under double endoscopes.The first stage stone free rate,operation time,hemoglobin decrease,complications,postoperative hospital stay and other conditions were analyzed.Results All the 23 operations were completed successfu

关 键 词：针状肾镜 输尿管软镜碎石术 顺逆行双镜联合 复杂性肾盏憩室结石 

分 类 号：R699[医药卫生—泌尿科学]