Clinical study and efficacy evaluation of Needle-perc combined with RIRS in the treatment of complex calyceal diverticular stone
Objective To retrospectively analyze and summarize the clinical experience and therapeutic effect of anterograde Needle-perc combined with RIRS,namely N+R(Needle perc+RIRS)technique in the treatment of complex calyceal diverticular stone.Methods Retrospective analysis of 23 cases of complex renal caliceal diverticulum stones admitted to our hospital from January 2020 to December 2022.The complex factors mainly include the invisible cervical orifice of diverticulum,large stone volume,and special anatomical location,which makes single RIRS or PCNL treatment difficult or unsuccessful.There were 14 males and 9 females with an average age of(42.3±6.1)years.Three cases were upper calyceal diverticular stone,average size was(0.9±0.2)cm.Nine patients had diverticular stone in the middle posterior calyx,and the average size was(1.2±0.3)cm.The average size of four diverticular stone was(1.8±0.2)cm in the anterior middle calyx.Seven patients had diverticular stone with an average size of(1.3±0.1)cm in lower calyx.Among them,12 patients underwent RIRS which were difficult or stone undiscovered,and 3 patients underwent PCNL and the operation was terminated due to failure of channel establishment.In our center,oblique supine lithotomy position(male)or prone split-leg position(female)was adopted,and the combined treatment of Needle-perc and RIRS was performed.Needle-perc puncture was completed under the guidance of full ultrasound.During the operation,methylene blue reagent or mutual guidance of two endoscopes was used to find the diverticulum neck and expand the outlet with holmium laser incision.Depending on the size and location of the stones,a single Needle-perc laser lithotripsy combined with stone removal in flexible ureteroscope was used,or dual lasers were be used simultaneously for stone removal under double endoscopes.The first stage stone free rate,operation time,hemoglobin decrease,complications,postoperative hospital stay and other conditions were analyzed.Results All the 23 operations were completed successfully.The stone free rate within 48 hours and one month after surgery was 78.2％and 100.0％respectively.The average operation time was(61.5±12.2)min.The mean postoperative hospital stay was(2.8±0.6)days.The mean decrease of hemoglobin was(3.6±0.4)g/L.Three patients had fever and one patient had renal subcapsular effusion.After anti-inflammatory and symptomatic treatment,the patient was discharged.There was no incidence of Clavien-Dindo≥Ⅱ complications such as blood transfusion,abdominal organ injury or urosepsis.Conclusions Treatment of complex renal caliceal diverticulum stones using N+R technique of anterograde needle-perc combined with RIRS can effectively improve the success rate of first-stage surgery.Overall,it is safe,efficient and feasible with the advantages of high stone free rate,lower damage,and few postoperative complications.
Needle-percRetrograde intrarenal surgeryDouble endoscopes combinationComplex calyceal diverticular stone
万方数据
维普
