CAJ | 학술논문

目的：探讨钬激光碎石联合肾盏憩室颈切开在经皮肾镜治疗肾盏憩室结石的安全性及疗效。方法回顾性分析18例采用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患者的病例资料。女性10例，男性8例；平均年龄40岁。18例均为肾后组的肾盏憩室结石，其中上盏憩室结8例，中盏憩室结石7例，下盏憩室结石3例，肾盏憩室结石合并肾盂结石2例。采用超声引导下直接穿刺结石所在的肾盏憩室，应用钬激光碎石，同时用钬激光切开狭窄的憩室颈。评估其结石清除率、并发症、结石复发率。结果16例患者一期单通道取石成功，1例一期双通道，1例二期取石，结石清除率100%，手术时间50min至130min，平均89.5±20.2min，术中出血量为30ml至200ml，平均出血量58±16.5ml。未出现大出血或邻近器官损伤等并发症，术后住院时间4d至8d，肾造瘘管留置时间1周至2周，术后随访6月至24月，17例患者憩室消失或者变小。结论：钬激光碎石联合肾盏憩室颈切开在经皮肾镜治疗肾盏憩室结石是安全有效的。
목적：탐토화격광쇄석연합신잔게실경절개재경피신경치료신잔게실결석적안전성급료효。방법회고성분석18례채용경피신경화격광쇄석연합신잔게실경절개치료신잔게실결석환자적병례자료。녀성10례，남성8례；평균년령40세。18례균위신후조적신잔게실결석，기중상잔게실결8례，중잔게실결석7례，하잔게실결석3례，신잔게실결석합병신우결석2례。채용초성인도하직접천자결석소재적신잔게실，응용화격광쇄석，동시용화격광절개협착적게실경。평고기결석청제솔、병발증、결석복발솔。결과16례환자일기단통도취석성공，1례일기쌍통도，1례이기취석，결석청제솔100%，수술시간50min지130min，평균89.5±20.2min，술중출혈량위30ml지200ml，평균출혈량58±16.5ml。미출현대출혈혹린근기관손상등병발증，술후주원시간4d지8d，신조루관류치시간1주지2주，술후수방6월지24월，17례환자게실소실혹자변소。결론：화격광쇄석연합신잔게실경절개재경피신경치료신잔게실결석시안전유효적。
Objective To investigate the safety and feasibility of holmium laser diverticular neck incision com-bined with percutaneous nephrolithotripsy in the treatment of caliceal diverticular calculi. Methods The data of 18 cases in our hospital of renal calceal diverticular calculi treated by percutaneous ultrasonic nephrolithotripsy and hol-mium laser, of that 10 were female and 8 were male with an average age of 40 years old were analyzed. These 18 cas-es had all kidney dorsolateral calceal diverticular calculi, of which 8 were upper diverticular cases, 7 were medium diverticular cases, 7 were lower diverticular and 2 were renal pelvic calculi merging calceal diverticular calculi. Stones were removed intact or flagmented with holmium laser lithotripsy by PCNL under the B ultrasound guidance in all patients,and the diverticular necks were incised with holmium laser, We analyzed the outcome, complications, and recurrence rate.Results 16 cases were rendered stone-free at one session, only 1 cases needed two percutaneous access pathways, 1 cases needed asecond nephroscopy for the residual stone. Total stone clearance was 100%. The whole duration of the operation was 50 to 130 minutes with an average of 89.5±20.2 minutes, and the blood loss was 30 to 200 ml and 58 ± 16.5 ml in average. With no massive hemorrhage, adjacent organ damaged or other complica-tions. The average hospital stay was 4 to 8 days and the time of nephrostomy tube indwelling is 1 to 2 weeks. At the average follow-up of 6 to 24 months, Postoperative IVU showed obliteration of diverticula or improved drainage in 17 patients. Conclusions Holmium laser diverticular neck incision combined with percutaneous nephrolithotripsy might be an effective and feasible treatment of renal calceal diverticular calculi.