可视穿刺经皮肾镜治疗肾盏憩室结石的临床研究

Clinical study of visual puncture percutaneous nephroscope in treatment of calculus diverticula

摘要:

摘要：目的??探讨可视穿刺经皮肾镜治疗肾盏憩室结石的安全性及临床价值。方法 回顾性分析2016年3月－2019年3月采用可视穿刺针式肾镜治疗肾盏憩室结石的患者12例。其中，男7例，女5例；平均年龄（38.4±12.6）岁；憩室位于左肾7例，右肾5例，其中肾上盏憩室结石5例，肾中盏憩室结石3例，肾下盏憩室结石4例，憩室平均最大径（21.3±5.2）mm；结石平均最大径（18.3±4.2）mm。3例患者术前曾行体外冲击波碎石（ESWL）治疗，术中均“一针见石”建立经皮肾通道后碎石。结果 12例患者均采用单通道，平均手术时间（54.4±23.3）min，术后住院时间（6.8±2.1）d。8例患者术后血红蛋白浓度下降，平均血红蛋白减少（9.8±4.3）g/L。12例患者均找到憩室管并扩张，1例患者术后出现发热，患者均未出现血气胸、肾周组织损伤等。术后第３天复查泌尿系平片，结石清除率达100.0%。10例患者术后4～10个月复查，8例患者憩室基本塌陷，2例憩室体积缩小达50.0%，憩室结石均无复发。结论 使用可视穿刺经皮肾镜治疗肾盏憩室结石更加安全、有效，建立经皮肾通道具有成功率高、出血少、创伤小和患者术后恢复快等优点，值得临床进一步推广应用。

Abstract:

Abstract: Objective?To investigate the safety and clinical value of F4.8 visual needle-type nephrolithotomy in treatment of renal pelvic stones.?Methods?Retrospective analysis was conducted of clinical data of 12 patients with renal pelvic stones treated with F4.8 platinum vertical needle-needle nephrolithotomy from March 2016 to March 2019, including 7 males and 5 females. The mean age was (38.4?±?12.6) years old, the diverticulum was located in 7 cases of left kidney, 5 cases of right kidney, including 5 cases of supraventricular calculi, 3 cases of renal diverticulum calculi, 4 cases of inferior tibiofibular calculi, and the mean maximum diameter of diverticulum was (21.3?±?5.2) mm, the average maximum diameter of the stone was (18.3?±?4.2) mm. Three patients underwent extracorporeal shock wave lithotripsy (ESWL) before operation. During the operation, the percutaneous renal channel was used to establish a percutaneous renal channel.?Results?All the 12 patients underwent single-channel operation. The average operation time was (54.4?±?23.3)?min, and the postoperative hospital stay was (6.8?±?2.1)?d. In 8 patients, the hemoglobin concentration decreased and the mean hemoglobin decreased (9.8?±?4.3) g/L. In 12 cases, the diverticulum tube was found and dilated, and 1 patient developed fever after operation. The patients did not have blood pneumothorax and perirenal tissue damage. On the third day after surgery, the urinary plain film was reviewed and the stone removal rate was 100.0%. Ten patients were reexamined 4 to 10 months after surgery. In 8 patients, the diverticulum was basically collapsed. In 2 cases, the volume of the diverticulum was reduced by 50.0%. There was no recurrence of diverticulum stones.?Conclusion?The use of F4.8 visual needle-type nephrolithotomy for the treatment of renal pelvic stones is safer and more effective. The establishment of percutaneous renal passage has the advantages of high success rate, less bleeding, less trauma, and quick recovery after surgery. It is worth further promotion in clinical practice.