肾盏憩室结石(CDS)的治疗方法既往多以开放手术为主,其对患者的创伤较大,住院时间较长,而随着微创技术的发展,逆行输尿管软镜、经皮肾镜等手术方式逐渐成为外科医生的首选,不仅减轻了外科医生的工作负担,也提高了患者的就医感受。但由于憩室的位置、分类、结石大小等不同,选择一种合适的手术方式尤为重要。每种手术方式各有其优缺点,每位外科医生的考量也各有不同,目前,国内外对于憩室结石的最佳手术方式无明确的定论,文章就肾盏憩室结石的诊疗进展作一综述。The treatment of renal calyceal diverticulum stones (CDS) used to be based on open surgery, which is more traumatic to patients and has a longer hospital stay, but with the development of minimally invasive technology, retrograde ureteral soft microscopy, percutaneous nephrolithotomy, and other surgical procedures have gradually become the surgeon’s first choice, which not only reduces the surgeon’s workload, but also improves the patient’s experience of medical treatment. However, due to the different locations, classifications, and stone sizes of diverticula, it is particularly important to choose an appropriate surgical procedure. Each surgical procedure has its own advantages and disadvantages, and each surgeon’s consideration is also different. At present, there is no clear conclusion on the best surgical procedure for diverticular stones at home and abroad, and this article provides a review of the progress in the diagnosis and treatment of renal calyceal diverticular stones.
目的研究楔形胃代膀胱术的适应证、效果及并发症.方法1992年5月至2003年12月,选择膀胱癌全膀胱切除术的病例,行楔形胃代膀胱术61例,均经尿道排尿.术后随访排尿情况、实验室检查、尿动力学检查、影像学检查、膀胱镜检及了解并发症等.结果61例术后随访5个月～12年,平均6年.排尿通畅者占70.49%(43/61);排尿间隔2～4.5 b,平均3 h;尿量280～520ml,平均385 ml;最大尿流率13～25 rml/s,平均17 ml/s;膀胱容量300～550 ml,平均375 ml;最大尿道压20～60 cm H2O,平均48 cm H2O;充盈期膀胱压5～14 cm H2O,平均11cm H2O;最大膀胱压40～65 cm H2O,平均55 cm H2O;排尿期最大膀胱压25～60 cm H2O,平均45 cm H2O.尿道吻合口狭窄者9.84%(6/61),电切后被纠正.膀胱颈切除术后尿失禁者为100%(12/12),占总病例的19.67%(12/61),术后3～6个月尿失禁渐缓解.尿道灼痛伴尿道口溃疡者9.84%(6/61),均为尿失禁者.无不稳定性膀胱.遗尿者32.65%(16/49).左输尿管原位与胃膀胱吻合致左肾输尿管积水者为100%(9/9),左输尿管经骶前腹膜后移至右侧与胃膀胱吻合者无此现象.剩余尿量(1～125 ml,平均30 ml)81.63%(40/49).尿潴留者2例.尿路感染者5例,均为排尿不畅者.血尿尿痛症者16.39%(10/61).酸性尿者100%(61/61),尿pH 4.5～7.0.附睾炎者1例.无幽门括约肌痉挛.术后第12个月发生膀胱颈吻合口肿瘤1例,作肿瘤切除术.术后1～5年内死于肿瘤转移者9例.术后膀胱镜检均见胃膀胱黏膜光滑平整,色泽稍苍白,未见溃疡,1年以上15例取胃膀胱黏膜作光镜及电镜观察,仅见胃膀胱黏膜间质内酸性细胞及淋巴细胞浸润.61例术后血电解质及动脉血气分析均未见明显异常,BUN及Cr值均在正常范围内.结论楔形胃代膀胱术效果好,并发症少.膀胱癌行全膀胱切除,不能保留尿道括约肌者,不宜采用经尿道排尿的原位胃膀胱术.
