PDF(Pubmed)
Abstract：
Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. Diagnosis is best made by intravenous urography or computed tomography urogram. Shock wave lithotripsy (SWL) is an option for first-line therapy in patients with stone-bearing diverticula that have radiologically patent necks in mid- to upper-pole diverticula and small stone burdens. Stone-free rates are the lowest with SWL, although patients report being asymptomatic following therapy in up to 75% of cases with extended follow-up. Ureteroscopy (URS) is best suited for management of anteriorly located mid- to upperpole diverticular stones. Drawbacks to URS include difficulty in identifying the ostium and low rate of obliteration. Percutaneous management is best used in posteriorly located mid- to lower-pole stones, and offers the ability to directly ablate the diverticulum. Percutaneous nephrolithotomy remains effective in the management of upperpole diverticula, but carries the risk of pulmonary complications unless subcostal access strategies such as triangulation or renal displacement are used. Laparoscopic surgery provides definitive management, but should be reserved for cases with large stones in anteriorly located diverticula with thin overlying parenchyma, and cases that are refractory to other treatment. This article reviews the current theories on the pathogenesis of calyceal diverticula. The current classification is examined in addition to the current diagnostic methods. Here we summarize an extensive review of the literature on the outcomes of the different treatment approaches.
摘要：
半球形憩室是上收集系统的罕见出囊，可能是先天性的。结石可以在高达50％的肾盏憩室中找到，虽然,在综合报道的系列中，96%的患者出现结石。诊断最好通过静脉尿路造影或计算机断层扫描尿路造影。冲击波碎石术（SWL）是患有结石憩室的患者的一线治疗选择，这些憩室在中上极憩室有放射学上的颈部专利，结石负担较小。SWL的无石率最低，尽管在延长随访的病例中，高达75％的患者报告在治疗后无症状。输尿管镜检查（URS）最适合用于治疗位于中上极憩室结石。URS的缺点包括难以识别口和闭塞率低。经皮管理最好用于位于中到下极的后部结石，并提供直接消融憩室的能力。经皮肾镜取石术在治疗上极点憩室方面仍然有效，但存在肺部并发症的风险，除非使用肋下通路策略，如三角测量或肾脏移位。腹腔镜手术提供了明确的管理，但应该保留用于前憩室有大结石且薄薄的上覆实质的病例，以及其他治疗难以治疗的病例。本文对肾盏憩室的发病机制进行了综述。除了当前的诊断方法之外，还检查了当前的分类。在这里，我们对不同治疗方法的结果进行了广泛的文献综述。
