| 熊康林,胡云飞,刘锦.后腹腔镜技术在治疗肾盏憩室结石中的应用[J].安徽医药,2018,22(11):2175-2179. |
| 后腹腔镜技术在治疗肾盏憩室结石中的应用 |
| Application of retroperitoneal laparoscopic technique in the treatment of calyceal diverticular calculi |
| 投稿时间：2016-10-10 |
| DOI： |
| 中文关键词: 肾盏憩室 结石 后腹腔镜 |
| 英文关键词: Calyceal diverticulum Stones Retroperitoneal laparoscopic |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨后腹腔镜技术在肾盏憩室结石治疗中的应用。方法 回顾性分析2010年3月至2015年6月武汉大学人民医院采用后腹腔镜技术治疗的16例肾盏憩室结石患者的临床资料,评估后腹腔镜技术治疗肾盏憩室结石的临床疗效。结果16例手术均获得成功。3例通过腹腔镜直接观察识别出肾盏憩室,6例通过输尿管导管注射亚甲蓝致覆盖在结石表面的肾实质变蓝而发现,7例注射亚甲蓝失败术中改用腹腔镜超声成功发现憩室位置。取尽结石后发现7例憩室颈部已闭塞,9例见憩室颈口,电灼颈口并缝合关闭憩室颈部,电灼憩室壁后均采用相邻的肾周脂肪填充憩室腔。平均手术时间为(129.5±32.3)min,平均失血量为(76.0±28.5)mL,平均住院时间为5.2 d。血红蛋白[术前(138.6±2.0)g·L-1vs.术后(129.8±2.1)g·L-1,P=0.85]、血肌酐[术前(43.3±3.9)μmol·L-1 vs.术后(46.6±2.7)μmol·L-1,P=0.50]等指标比较均差异无统计学意义。无术后并发症发生。随访6~18个月,所有患者均未再出现腰痛、反复泌尿系感染和肉眼血尿等症状,静脉尿路造影检查和超声检查未发现患侧憩室和结石复发。结论 后腹腔镜对于靠近肾盏憩室有明显的技术优势,可以降低出血的风险,后腹腔镜技术治疗肾盏憩室结石能有效取尽结石和封闭憩室腔,它可作为经皮肾镜、体外冲击波碎石术、输尿管镜治疗肾盏憩室结石失败后首选的替代方法,对肾脏憩室类结石的治疗值得临床进一步探讨。 |
| 英文摘要: |
| Objective To investigate the application of retroperitoneal laparoscopic technique in the treatment of calyceal diverticular calculi.Methods The clinical data of 16 cases of calyceal diverticulum stones undergoing retroperitoneal laparoscopy in Renmin Hospital of Wuhan University from March 2010 to June 2015 were retrospectively analyzed.The clinical efficacy of laparoscopic technique in the treatment of calyceal diverticular calculi was evaluated.Results All 16 cases of operation were successful.Three cases of calyceal diverticulum were treated directly by laparoscope,and 6 cases were treated by giving the patients methylene blue injection through the ureteral catheter to turn the renal parenchyma blue on the stone surface,another seven cases of failed methylene blue injection were successfully treated with laparoscopic ultrasonography to find diverticulum.After removing the stones,7 cases were found obstruction of the diverticulum neck,while diverticulum neck of 9 cases can be seen;the neck underwent electrocautery and was sutured to close,and electrocautery of diverticulum wall was used followed by adjacent renal fat filling diverticulum cavity.The mean operative time was (129.5±32.3) min,mean blood loss was (76.0±28.5) mL,and the average hospital stay was 5.2 days;the hemoglobin [preoperative (138.6±2.0) g·L-1 vs.postoperative (129.8±2.1) g·L-1,P=0.85],serum creatinine [preoperative (43.3±3.9) μmol·L-1 vs.postoperative (46.6±2.7) μmol·L-1,P=0.50] had no statistically significant differences.No postoperative complications occurred.All patients were followed up for 6 months to 18 months.No recurrence of low back pain,recurrent urinary tract infection and gross hematuria was found.No recurrence of ipsilateral diverticula and stones was found in intravenous urography (IVU) and ultrasonography.Conclusion The retroperitoneal laparoscopy has the obvious technical superiority to get close to the renal calyceal diverticulum,which can reduce the risk of bleeding.Retroperitoneal laparoscopic treatment of calyceal diverticular calculi is effective in removing the stones and closing the diverticulum cavity.It can be used as the preferred alternative method when percutaneous nephrolithotomy (PCNL),extracorporeal shock wave lithotripsy (ESWL) and ureteroscope (URS) fail to treat calyceal diverticulum stones.The treatment of renal diverticular calculi is worth further study in clinic. |
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