超声引导穿刺辅助输尿管软镜治疗肾盏憩室结石16例并文献复习

doi:10.13418/j.issn.1001-165x.2016.04.022

摘要/Abstract

摘要：

目的　探讨超声引导经皮肾盏憩室穿刺辅助输尿管软镜（FURS）治疗肾盏憩室结石的临床价值，复习相关文献以提高对本病的认识。方法　回顾性分析2014年8月至2015年7月共16例FURS寻找憩室开口困难患者，男7例，女9例，中位年龄48岁（27~83岁）。结石最大径中位数为12 mm（6-24 mm）。斜仰卧截石位，超声辅助经皮穿刺憩室并注入美兰或插入导丝辅助FURS治疗憩室结石。结果　16例均穿刺成功。10例经针鞘注入美兰后FURS可见蓝色液体自憩室口流出，6例未见蓝色液体流出。后6例经穿刺针鞘置入导丝辅助FURS辨认憩室位置并切开。16例均成功用钬激光切开憩室颈口或憩室壁，击碎并清除憩室内结石。无石率、碎石成功率和无症状率分别为75%（12/16）、87.5%（14/16）和100%（14/14）。术后2例发热经抗生素治疗后好转。中位住院时间为3d（2~5 d）。憩室术后3月6例消失，10例缩小。结论　超声引导穿刺有助于FURS辨认肾盏憩室开口和位置，可能有助于提高的手术成功率。

关键词: 肾盏憩室, 肾盏憩室结石, 输尿管软镜, 经皮肾镜取石术, 穿刺, 超声

Abstract:

Objective　To evaluate the value of flexible ureteroscope (FURS) for management of renal calyceal diverticulum calculi with ultrasound guided punctureof diverticulum.　Methods　Combined with reviewing the relevant literature, we retrospectively analyzed the clinical data of 16 cases of diverticular calculi. From August 2014 to July 2015, 7 men and 9 women with an median age 48 years among them, 14 patients sustained symptomatic caliceal diverticulum calculi while 2 patients were symptoms free. Those patients were treated by FURS. FURS recognition of diverticulum ostium with ultrasound guided puncturing intodiverticular cavity in lateral lithotomy position was performed. After the needle entered diverticular cavity, saline-diluted methylthioninium chloride was injected or guidewires were inserted gently through needle sheaths. At the same time, the orifice or wall of the diverticular cavity was recognized under FURS. A 200-mm holmium laser fiber was used to incise the stenotic infundibulum or diverticular wall. Diverticular calculi was fragmented and washed out of the diverticulum. Larger fragments were extracted with basket.　Results　Of the 16 cases, calyceal diverticulum necks leading to calyx were identified in 10 cases, and another 6 cases were not found but their locations were determined. The diverticular walls of the later 6 cases were incised with laser. The stone free rate, fragment success rate and symptom free rate was 75%（12/16）, 87.5%（14/16）and 100%（14/14）, respectively. Two cases underwent repeated procedure for the residual fragments, and the fragments were all cleared successfully after second surgery. Diverticula became disappeared or shrunk in 6 and 10 cases 3 months after the operation, respectively. Conclusion　Flexible ureteroscope combined with the ultrasound guided puncture of diverticular cavity for management of caliceal diverticulum calculimay provide a safe and an effective option. Ultrasound guided needle puncture into calyceal diverticulum may facilitate flexible ureteroscopic treatment of calyceal diverticulum calculi.

Key words: Calyceal diverticulum, Calyceal diverticulum calculi, Flexible ureteroscope, Percutaneous nephrolithotomy, Puncture, Ultrasound

张际青,　康宁,　邱智,　张军晖. 超声引导穿刺辅助输尿管软镜治疗肾盏憩室结石16例并文献复习[J]. 中国临床解剖学杂志, 2016, 34(4): 460-463.

ZHANG Ji-qing, KANG Ning, QIU Zhi, ZHANG Jun-hui. Flexible ureteroscope for management of calyceal diverticulum calculi with ultrasound guided puncture for 16 cases and literature review[J]. Chinese Journal Of Clinical Anatomy, 2016, 34(4): 460-463.

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