| Objective: To explore the clinical application value outlet internalincision using transurethralflexible ureteroscopy and holmium laserto treat the complicatedcalyceal diverticular calculi,with statistical analysis.Methods:Retrospective analysis between June 2015 and December 2016,the first affiliated hospital of Zhengzhou universityurology department treatcalyceal diverticular calculi patients with 28 cases,choose the kidney complicated calyx diverticulum patients with calculi 16 cases of men,12 cases of women,mean age is 42.1 years(aged 26 to 65).Then 15 cases in the upper pole,9 cases in the middle pole and 4 cases were located in the lower pole.15 cases of diverticulum stone were located in the right kidney,and 13 cases of diverticular calculi were located in the left kidney.The averagemeasurement from CT imaging calculi located in(1.53 + 0.32)cm.Preoperative perfect CTU(Computed Tomography Urography)or IVU angiography(Intravenous Urography),renal function and urine culture in order to make clear diagnosis and eliminate contraindications.Among which 28 cases were directly used transurethral flexible ureteroscopy and holmium laser in the treatment of complicated calyceal diverticular calculi in the surgery.Then4 patients had ESWL(Extracorporeal Shock Wave Lithotripsy)treatment in the other hospital before operation of flexible ureteroscopy and holmium laser.The patients with ESWL had no stones discharge,then had to recept flexible ureteroscopy treatment.Of which 3 cases with the calyceal diverticular calculiwere suffered nephroscope channel of gravel(minimally invasive percutaneous nephrolithotomy,MPCNL)in the outer hospital,among which postoperative ridgeway residues,thencoming to our department to recept flexible ureteroscopy and holmium laserin gravel again.Patients were with general anesthesia and lithotomy position tobe operated with the electronic flexible ureteroscopy and holmium laserin gravel todetect each calyces and lithotripsy.Results:Among the 28 cases,first using the electronic flexible ureteroscopy and holmium laser with calyceal diverticular endoscopic incision to treat the stones and gravel.28 cases were complicated,including 3 cases with flexible ureteroscopy directly through the diverticulum cervical mouth and complete gravel stone,18 patients with calyceal diverticular narrownessbecause the neck is long and narrow,3 cases is close to the atresia and it is difficult to find the cervical mouth and stone.Then using holmium laser to cut neck mouths,injection of methylene blue from flexible ureteroscopy working channel or percutaneous fine needle puncture diverticulum with ultrasound guided and electronic flexible ureteroscopy scene to look for neck and calyces diverticulum.Among the rest 4 cases with lower pole calyceal diverticular,2 cases with holmium laser optical fiber limited and difficult for flexible ureteroscopy bending angle,with sets of stone basket to pull stone to the neck and lithotripsy gravel succeed.28 cases are performed successfully.The average operation time(89.6±4.5)minutes,the average intraoperative blood loss estimate(8.34 ± 0.3)milliliter.Of which 28 cases of intraoperative are all operated with transurethralflexible ureteroscopy and holmium laser diverticulumneckincision to findstones then lithoclasty.Positioning success rate of 100%.Among which 2 cases of patients with postoperative body temperature more than 38.5? accompanied by chills,doubting in urine infection source and fight against with sensitive antibiotics,no other serious complications appeared.for postoperative indwelling of ureteral stents Double J tube(D-J)and oral drugs for one to two months.Respectively after one or two months review bilateral renal CT scan.Postoperative review double kidney scan CT,one month and two months calculi residue rate respectively 18.0 % and 3.0%.Conclusion: For strict screening cases,especially in theupper pole of the kidney and extremely to the calyces diverticulum stonesin the front of the middle pole,because the parts are not conducive to the establishment of percutaneous nephroscope lithotripsy channel,preciselyflexible ureteroscopy and holmium laser to make up for the shortcomings,namely retrograde flexible ureteroscopy and holmium laser diverticulumneckincision of renal calices and gravel lithotomy to treat calyces diverticulum calculus with wee cervical mouth.For this operation,finding calyces diverticulum cervical mouth intraoperativeis the key to success,so preoperatively the patients should perfect the CTU or IVU to facilitate diverticulum positioning,intraoperatively retrograde methyleneblue injectioncan pinpoint calyces diverticulum neck tiny exports.Although the calyces diverticulum cervical mouth are most stenosis or atresiaaccompany,the ultrasonic assisted percutaneous fine needle puncture diverticulum injection of methylene blue assist flexible ureteroscopy for cervical mouth.For lower pole calyces diverticulum calculi because of the soft lens bending angle problem,setting the stone basket to help pull the stone tocervical mouth then gravel,or to change professions PCNL.In summary,cervical mouth incision using transurethral flexible ureteroscopy and holmium laser in the treatment of upper and middle calyx diverticulum calculi with safer,more minimally invasive,quick recovery,less complications,especially can be used as a very advanced technology and had the advantage of handling the calyx and calyces diverticulum calculi surgery,being worthy of clinical promotion. |
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