CAJ | 학술논문

目的探讨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的安全性及有效性. 方法回顾性分析2008年1月至2010年12月输尿管软镜钬激光碎石术治疗23例合并临床症状的肾盏憩室结石患者资料.男15例,女8例.年龄23～68岁,平均44岁.主要特点为腰痛、血尿,尿路感染.10例曾行ESWL治疗,其中l例曾行2次ESWL.23例均为单侧肾盏憩室结石,结石位于肾上极11例,中部9例,下极3例.成堆泥沙样多发结石19例,单发结石4例.结石最大直径18.9 mm.术前1周均留置双J管,均行IVU及双肾CT检查.静脉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,憩室内大部分结石呈泥沙样聚集,小部分结石较大,予以钬激光碎石,结石碎屑随灌洗液冲出或用套石篮取出. 结果本组23例均顺利置入输尿管软镜,一次进镜成功率100％.22例顺利寻及憩室结石,1例术中未寻及憩室开口改行PCNL,手术顺利.碎石成功20例(87.0％),术后无结石残留15例(65.3％).残留结石＜4 mm者5例；3例碎石失败者结石残块≥4 mm.平均手术时间60min,术后平均住院日3.5d.手术无并发症发生.术后随访6～12个月,患者症状均消失,未见结石复发. 结论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安全、有效,可作为临床首选治疗方法.
목적 탐토수뇨관연경화격광쇄석술치료합병림상증상적신잔게실결석적안전성급유효성. 방법 회고성분석2008년1월지2010년12월수뇨관연경화격광쇄석술치료23례합병림상증상적신잔게실결석환자자료.남15례,녀8례.년령23～68세,평균44세.주요특점위요통、혈뇨,뇨로감염.10례증행ESWL치료,기중l례증행2차ESWL.23례균위단측신잔게실결석,결석위우신상겁11례,중부9례,하겁3례.성퇴니사양다발결석19례,단발결석4례.결석최대직경18.9 mm.술전1주균류치쌍J관,균행IVU급쌍신CT검사.정맥복합마취하행수뇨관연경화격광쇄석술,류치수뇨관확장초,치입수뇨관연경저체신우,심급게실개구,필요시용화격광절개게실경부,게실내대부분결석정니사양취집,소부분결석교대,여이화격광쇄석,결석쇄설수관세액충출혹용투석람취출. 결과 본조23례균순리치입수뇨관연경,일차진경성공솔100％.22례순리심급게실결석,1례술중미심급게실개구개행PCNL,수술순리.쇄석성공20례(87.0％),술후무결석잔류15례(65.3％).잔류결석＜4 mm자5례；3례쇄석실패자결석잔괴≥4 mm.평균수술시간60min,술후평균주원일3.5d.수술무병발증발생.술후수방6～12개월,환자증상균소실,미견결석복발. 결론 수뇨관연경화격광쇄석술치료합병림상증상적신잔게실결석안전、유효,가작위림상수선치료방법.
Objective To evaluate the therapeutic effect of flexible ureterorenoscopy (F-URS) with holmium laser lithotripsy in managing symptomatic caliceal diverticular calculi. Methods The records of 23 patients by flexible ureterorenoscopy (F-URS) with holmium laser lithotripsy in managing symptomatic caliceal diverticular calculi from January 2008 to December 2010 were retrospectively reviewed.The 23 cases included 15 males and 8 females,aged from 23 to 68 years.All patients had unilateral calyceal diverticulum stone,with 11,9,and 3 cases had a caliceal diverticular stone in the upper pole,midkidney,and lower pole,respectively.Sand-like stones were observed in most caliceal diverticular.The diameter of the largest stone was 18.9 mm.The presenting symptoms were flank pain,recurrent urinary tract infections,and hematuria.One week before operations,all patients was placed Double-J stent and underwent intravenous urography and renal computed tomography (CT).The ureteral access sheath was placed firstly during operation,and then ureterorenoscope was inserted into the renal pelvis.The diverticular neck was incised with holmium laser if needed,and a 200um holmium laser fiber was used to crush diverticular stone. Results Flexible ureterorenoscopes were successfully placed in all patients.Postoperatively,15 (65.3％ patients were rendered stone free (SF),5 patients had clinically insigni? cant residual fragments less than 4 mm )( CIRF),and a residual fragment (RF) was found in three patients.The success rate ( SF ± CIRF) was 87.0％.All patients were symptom free after operation.The average operative time and hospital stay were 60 minutes and 3.5 days,respectively.No severe complications occured.A follow-up of 6 -12 months showed no recurrence. Conclusions F-URS using a holmium laser lithotripsy is a safe and effective,and may be offered as a first line therapy for symptomatic caliceal diverticula calculi.