Ganpule Arvind, Patil Abhijit, Singh Abhishek, Sabnis Ravindra, Desai Mahesh
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.
J Endourol Case Rep. 2020 Mar 11;6(1):22-25. doi: 10.1089/cren.2019.0087. eCollection 2020.
Migration of Hem-O-Lok clips in pelvicaliceal system after nephron-sparing surgery (NSS) is rare. We present a rare case of clip migration 8 years after robotic NSS. A 61-year-old female presented with right flank pain and fever 8 years after robotic NSS for clear cell carcinoma. She was reported to have an 11 mm right renal calculus (570 HU) on CT scan. She underwent flexible ureteroscopy that revealed three Hem-O-Lok clips with encrustations. We removed the clips after laser lithotripsy of the encrusted clips. She is now asymptomatic on follow-up. The possibility of intrarenal migration of Hem-O-Lok clips should be kept as differential diagnosis for patients presenting as renal calculus postminimal access NSS. They could act as nidus for stone formation, leading to recurrent urinary infection. Excessive tension on renorrhaphy sutures should be avoided to prevent migration of clips. The underrunning of any clip in the renal bed during reconstruction should be the standard of care.
保留肾单位手术（NSS）后Hem - O - Lok夹在肾盂肾盏系统中的移位很少见。我们报告了1例机器人辅助NSS术后8年发生夹移位的罕见病例。一名61岁女性在接受机器人辅助NSS治疗透明细胞癌8年后出现右侧腰痛和发热。CT扫描显示她有一枚11毫米的右肾结石（570 HU）。她接受了输尿管软镜检查，发现3个有结痂的Hem - O - Lok夹。我们在对结痂夹进行激光碎石后取出了夹子。她目前在随访中无症状。对于微创NSS术后表现为肾结石的患者，应将Hem - O - Lok夹肾内移位的可能性作为鉴别诊断考虑。它们可能成为结石形成的核心，导致反复尿路感染。应避免肾缝合线上的张力过大以防止夹子移位。重建过程中在肾床对任何夹子进行褥式缝合应作为标准操作规范。
