中国冶金工业医学杂志

输尿管软镜联合钬激光治疗肾盏憩室结石19例临床分析

作者：刘正东

单位：四川结石病医院四川成都 610031

分类号：R 656

出版年,卷(期):页码：2016,33(1):4-5

摘要：

摘要：目的探讨输尿管软镜联合钬激光治疗肾盏憩室结石的安全性、有效性。方法回顾分析2012年1月至2014年9月采用输尿管软镜联合钬激光碎石治疗肾盏憩室结石19例患者资料。曾行ESWL 8例，其中2例曾接受2次ESWL。术前IVU及双肾CT检查明确诊断。气管插管静吸复合麻醉下行输尿管软镜钬激光碎石术，留置输尿管扩张鞘，置入输尿管软镜抵达肾盂，寻及憩室开口，必要时用钬激光切开憩室颈部，钬激光碎石，套石篮套取结石。结果17例顺利放置Cook输尿管扩张鞘并置入输尿管软镜，2例置入Cook输尿管扩张鞘困难留置F 5双J管4周再行输尿管软镜碎石术。一次放置镜鞘并碎石碎石成功14例，2例第1次留置F 5双J管4周后成功碎石，输尿管软镜成功碎石16例，术后无结石残留15例，结石残块＞4 mm 1例。输尿管软镜钬激光碎石失败3例。结论输尿管软镜联合钬激光碎石术治疗肾盏憩室结石安全、有效，可作为临床首选治疗方法。

关键词：肾盏憩室结石；输尿管软镜；钬激光

Abstract:ObjectiveTo investigate the safety,effectiveness of flexible ureterorenoscopy (F\|URS) combined holmium laser for renal calyceal diverticular calculiMethodsThe records of 19 patients with caliceal divertieular calculi treated by F\|URS holmium laser lithotripsy from January 2012 to September 2014 were retrospectively analyzed8 cases had been treated by ESWL including 2 cases by twice ESWLsIVU and CT were undertaken to diagnose before operationF\|URS holmium laser lithotripsy was performed with anesthesia using endotracheal intubation and intravenous inhalationThe ureteral access sheath was placed,and then ureterorenoscope was inserted into the renal pelvis,the opening of the divertieular was found,the neck of divertieular was incised with holmium laser if needed， holmium laser was used to crush divertieular stone，and stone were removed by stone basketResultsCook dilatation of ureter sheath and flexible ureterorenoscopes were successfully done in 17 cases,and there were 2 cases of difficultly placing Cook dilatation of ureter sheath being succeeded with F\|URS lithotripsy after indwelling F5 double J tube for 4 weeks,14 cases being succeeded only once,16 cases being succeed with flexible ureterorenoscopes lithotripsy15 cased of residual stones after operation,1 case of residual fragments more than 4 mm,3 cases being failed with F\|URS with holmium laser lithotripsyConclusionF\|URS combined holmium laser lithotripsy for treatment of renal calyceal diverticular calculi is safe and effective，and can be used as the preferred clinical treatmentKey Words:Renal calyceal diverticular calculi;Flexible ureteroscope;Holmium laser

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参考文献：

1］Staios Dimitrios,Andrews Henry O,Shaik Taufiq,et alQuality of life after percutaneous nephrolithotomy for caliceal diverticulum and secluded lower\|pole renal stones \[J\]Journal of endourology / Endourological Society,2007,21(5):515\|519

\[2\]杨春,高小峰,周铁,等输尿管软镜钬激光碎石术治疗合并临床症状的肾盏憩室结石\[J\]中华泌尿外科杂志,2012,33(1):16\|18

\[3\]张轶庠,张朝霞,陈合群,等输尿管软镜联合钬激光治疗有症状肾盏憩室结石(附32例报道)\[J\]中国内镜杂志,2014,20(2):146\|149

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