Division of Urology, Department of Surgery, The University of Western Ontario, London, Ontario, Canada.
J Endourol. 2011 Nov;25(11):1741-5. doi: 10.1089/end.2011.0046. Epub 2011 Aug 18.
Caliceal diverticula are rare renal anomalies present in approximately 0.6% of the population. They are associated with calculi in 50% of cases. Therapeutic options include several minimally invasive techniques. We report a retrospective review of outcomes and complications from our series of patients who were treated with a percutaneous approach.
A database of outcomes related to percutaneous nephrolithotomy (PCNL) has been maintained at our institution since 1992. Data on all patients with caliceal diverticular stones who underwent PCNL during a 17-year period from 1992 to 2009 were reviewed retrospectively. Our preferred approach to PCNL in these patients is to puncture directly into the diverticulum and to try to advance a guidewire through the infundibular neck. In cases where the caliceal neck could not be intubated, we performed a transdiverticular approach with creation of a neoinfundibulum as a salvage procedure. We evaluated the two techniques with regard to stone-free rates and early postoperative complications.
Seventy-six procedures were performed. The mean age was 43 years (range 17-72 y). The mean stone area was 583 mm(2). The surgical approach was direct puncture in 47, transdiverticular in 20, retrograde in 8, and unknown in 1 patient. Eight patients underwent lining fulguration. The average duration of surgery was 75 minutes (23-169 min) with an average hospital stay of 4.7 days. There were a total of 23 complications, of which 11 necessitated additional intervention. The overall stone-free rates were 77% and 89% for direct puncture and transdiverticular approaches, respectively.
The percutaneous management of caliceal diverticular calculi is highly effective and can be accomplished with low morbidity.
肾盏憩室是一种罕见的肾脏先天畸形，约占人群的 0.6%。其中 50%的病例与结石相关。治疗方法包括多种微创技术。我们报告了对一组接受经皮途径治疗的患者的治疗结果和并发症进行回顾性分析。
自 1992 年以来，我们的机构一直在维护与经皮肾镜取石术（PCNL）相关的结果数据库。回顾性分析了 1992 年至 2009 年 17 年间接受 PCNL 治疗的肾盏憩室结石患者的所有数据。对于这些患者，我们首选的 PCNL 方法是直接穿刺进入憩室，并尝试通过漏斗颈引导导丝。如果无法插入肾盏颈部，则作为挽救性手术进行经憩室途径。我们评估了这两种技术的结石清除率和术后早期并发症。
共进行了 76 例手术。患者的平均年龄为 43 岁（17-72 岁）。结石平均面积为 583mm²。手术途径为直接穿刺 47 例，经憩室途径 20 例，逆行途径 8 例，1 例未知。8 例患者接受了衬里电灼术。手术平均时间为 75 分钟（23-169 分钟），平均住院时间为 4.7 天。共有 23 例并发症，其中 11 例需要进一步干预。直接穿刺和经憩室途径的结石清除率分别为 77%和 89%。
经皮治疗肾盏憩室结石非常有效，且发病率低。
