肾盏憩室结石的微创治疗进展

doi:10.3877/cma.j.issn.1674-3253.2026.01.016

肾盏憩室是一种相对少见的先天性肾畸形疾病，发病率为0.21%~0.45%，常伴随结石形成，可引起疼痛、血尿或反复泌尿系统感染等临床症状。治疗方法包括体外冲击波碎石术、经皮肾镜碎石取石术（PCNL）、输尿管软镜碎石术（FURL）、腹腔镜手术及传统开放手术等。随着微创技术的发展，PCNL和FURL已成为主要治疗方法，但最佳术式选择仍存在争议。PCNL的优势在于结石清除率高（87.5%~100%），憩室闭合率可达76%~100%，可通过憩室壁电灼或憩室颈切开扩张术处理憩室，但存在出血、肾实质损伤等风险，术后恢复时间较长。FURL具有创伤小、恢复快、术后炎症反应轻等优点，结石清除率同样较高，特别适合直径<2 cm的中上盏憩室结石，但对于下盏或颈部狭窄的憩室处理较困难。本文对肾盏憩室结石的微创治疗进展进行综述。

关键词: 肾盏憩室, 结石, 经皮肾镜, 输尿管软镜, 微创

Calyceal diverticulum is a relatively rare congenital renal malformation with an incidence of 0.21%-0.45%, frequently accompanied by stone formation, which may cause pain, hematuria, or recurrent urinary tract infections. Treatment options include extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy (PCNL), flexible ureteroscopic lithotripsy (FURL), laparoscopic surgery, and traditional open surgery. With advances in minimally invasive techniques, PCNL and FURL have become the primary treatment modalities, though optimal surgical selection remains controversial. The advantages of PCNL including high stone clearance rates (87.5%-100%) and diverticular closure rates (76%-100%) through diverticular wall fulguration or neck incision, but carries risks of bleeding, renal parenchymal injury, and prolonged recovery. FURL demonstrates minimal trauma, rapid recovery, and reduced postoperative inflammatory response with high stone clearance rates, particularly suitable for stones <2 cm in the upper-middle calyces, though challenging for lower calyceal or narrow-necked diverticula. This article aims to review the progress in minimally invasive treatment of calyceal diverticulum stones.

Key words: Calyceal, Calculus, Percutaneous nephrolithotomy, Flexible ureteroscopic lithotripsy, Minimally invasive

表1 PCNL与FURL治疗肾盏憩室结石对比

	PCNL	FURL
结石清除率	87.5%~100%^[29]	90%^[46]
无症状率	90%^[29]	88.9%^[50]
憩室闭合率	憩室闭合率为76%~100%，可处理憩室，促进憩室闭合^[29,51]	定位憩室较困难^[49]
手术限制	结石大小及位置的限制较少	处理直径>2 cm及位于下盏的结石面临挑战^[49]
术中出血	较多^[23,29]	少
术后创伤	处理位于肾上极或腹侧部位的肾盏憩室时，可能会增加严重并发症的发生风险^[29]	创伤小，恢复快^[43]
术后应激及炎症反应	相对较重	创伤较轻，术后应激及炎症反应较轻^[23]
并发症发生率	>10%^[23]	5%~10%^[23]
住院时间	较长，6~7天^[29]	较短，3~4天^[29]

表1 PCNL与FURL治疗肾盏憩室结石对比

	PCNL	FURL
结石清除率	87.5%~100%^[29]	90%^[46]
无症状率	90%^[29]	88.9%^[50]
憩室闭合率	憩室闭合率为76%~100%，可处理憩室，促进憩室闭合^[29,51]	定位憩室较困难^[49]
手术限制	结石大小及位置的限制较少	处理直径>2 cm及位于下盏的结石面临挑战^[49]
术中出血	较多^[23,29]	少
术后创伤	处理位于肾上极或腹侧部位的肾盏憩室时，可能会增加严重并发症的发生风险^[29]	创伤小，恢复快^[43]
术后应激及炎症反应	相对较重	创伤较轻，术后应激及炎症反应较轻^[23]
并发症发生率	>10%^[23]	5%~10%^[23]
住院时间	较长，6~7天^[29]	较短，3~4天^[29]

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Progress in minimally invasive treatment of calyceal diverticulum stones

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Progress in minimally invasive treatment of calyceal diverticulum stones