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目的探讨微创经皮肾镜钬激光碎石联合肾盏憩室颈切开治疗肾盏憩室结石的临床疗效。方法回顾分析我院采用微创经皮肾镜钬激光碎石联合肾盏憩室颈部狭窄切开治疗22例肾盏憩室结石患者的临床资料,总结肾盏憩室结石微创治疗的经验和对策。本组患者女性10例,男性12例;平均年龄35.6岁。其中肾上盏憩室结石10例,肾中盏憩室结石5例,肾结石合并肾盏憩室结石7例。采用B超定位引导直接穿刺结石所在之肾盏憩室,应用钬激光碎石,同时以钬激光切开憩室颈部狭窄。结果7例肾结石合并肾盏憩室结石患者中,5例行一期双通道取石,2例行二期经皮肾镜取石;余15例患者均一期微创经皮肾镜成功取石。术后复查22例均无结石残留。手术时间为25～120min,平均45min;术中出血15～80ml,平均35ml。无术后严重并发症发生,无中转开放手术病例,术后7～12d出院。结论微创经皮肾镜钬激光碎石创伤小,清除结石的同时可以应用钬激光行肾盏憩室颈部狭窄的切开,为有症状的肾盏憩室结石患者提供一种微创治疗的选择。
Objective To investigate the clinical effect of minimally invasive percutaneous nephrolithotomy combined with holmium laser lithotripsy in the treatment of calyceal diverticula calculus. Methods A retrospective analysis of our hospital with minimally invasive percutaneous nephrolithotomy holmium laser lithotripsy and calyceal diverticulum neck stenosis in the treatment of 22 cases of calyceal diverticula calculus patients with clinical data to summarize the experience and countermeasure of calyceal diverticula calculus minimally invasive treatment. The group of 10 patients with females, 12 males; average age 35.6 years old. Among them, 10 cases were calyceal diverticula calculus, 5 cases were calyceal diverticula calculus, and 7 cases were renal calculus with calyceal diverticula calculus. B-guided positioning with direct puncture calculus calyceal diverticulum, holmium laser lithotripsy, holmium laser at the same time cut open the diverticulum neck stenosis. Results Among the 7 patients with calculus of calyceal diverticula calculus, 5 patients underwent one-stage double-channel lithotomy and 2 patients underwent second-stage percutaneous nephrolithotomy. All the remaining 15 patients underwent minimally invasive percutaneous nephrolithotomy. Postoperative review of 22 cases no stone residue. Surgery time was 25 ~ 120min, an average of 45min; intraoperative bleeding 15 ~ 80ml, an average of 35ml. No serious postoperative complications occurred, no transfer of open surgery cases, 7 to 12 days after discharge. Conclusion minimally invasive percutaneous nephrostoscopic holmium laser lithotripsy trauma, clear stones at the same time can be used in the holmium otolaryngology diverticulum neck stenosis incision for the symptomatic patients with calyceal diverticula calculus a minimally invasive treatment options .