曾国华-软镜联合钬激光概览.ppt

临床资料clinical data 术前影像资料二：CT Radiology findings（2）： CT 讨论1：憩室结石最佳术式?Discussion 1： The best option for caliceal diverticular stones ？ 本次处理：输尿管软镜钬激光碎石术Management： F-URS with Holmium Laser 术后6天复查：KUB 讨论2： F-URS联合YAG 激光治疗憩室结石手术要点 Keys to the F-URS with YAG 1，确认憩室颈 2，钬激光环切与碎石 病例讨论：憩室结石的临床处理 Management of Caliceal Diverticular Stones：A case report 广州医学院第一附属医院微创中心 Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical College 曾国华 Zeng Guohua 1.40岁男性，因“左侧腰痛，伴肉眼血尿1周”入院。 2.查体：左肾区叩痛（+），余无特殊。 3.手术史：曾行ESWL失败。 4.结合影像资料诊断为：左侧上极憩室结石 1.A 40 yrs old man，with left flank pain and macroscopic haematuria for one week, was admitted to hospital . 2. Physical examination: Pain to percussion in left renal area. 3. Operation history ： failed in ESWL 4. Diagnosis combined the Radiology date: caliceal diverticular stone in left upper pole kidney 术前影像放射科资料一：IVP Radiology findings（1）： IVP ESWL? URS? PCNL? Open Surgery ? Stone completely clear confirmed by KUB post-operate 6 days 1.憩室的发病率1% ；憩室患者结石发生率为10–50% 1. Incidence of diverticula 1% ; calculi within calyceal diverticula:10–50% 2.有症状的憩室结石是手术指证。清除结石和扩大憩室颈是治疗目的。 2. Indication for treatment: A symptomatic stone-bearing diverticulum is an. Aim : remove the stone and enlarge the diverticular neck to avoid recurrence 3.文献报告的治疗憩室结石的结果： Results of the treatment of diverticula stone in previous literatures: 88届AUA大会Dretler提出治疗憩室结石的手术选择： Dretler had described an endoscopic classi?cation as: (1) large neck (treatable by SWL); (2) narrow and short neck (treatable by F-URS); (3) narrow and long neck (treatable by PCNL); (4) closed neck 其他文献综述对憩室结石治疗的观点*： Some other viewpoint on the issue： ESWL:结石直径小于1cm，憩室颈显影，缺点:引流不理想 PCNL:结石直径大于1cm，多发性结石，憩室颈狭窄，缺点：通道较多的穿过实质时，出血风险大 URS:经ESWL或PCNL治疗失败，或上盏中盏的小结石，缺点:不适合 大结石 ESWL: stone is 1 cm，neck is radiographically patent. Drawback: poor ability of drainage PCNL: stone is 1 cm ，multiple stones，narrow diverticular neck Drawba