超声引导下输尿管软镜钬激光肾盂旁囊肿切开内引流术的临床分析

Clinical analysis of ultrasound-guided transurethral flexible ureteroscopic holmium laser incision and internal drainage for parapelvic cysts

摘要:

目的 探讨超声引导下经尿道输尿管软镜钬激光切开内引流术治疗肾盂旁囊肿的安全性和有效性。方法 收集2014年11月－2019年3月民航总医院收治的肾盂旁囊肿患者的临床资料。该组共23例，男12例，女11例，年龄33～75岁，平均58.3岁。腰痛6例，余为体检发现。合并同侧肾结石5例，合并同侧肾盂肾盏积水16例，合并患侧肾功能受损者1例。术前超声、泌尿系CT增强提示肾盂旁囊肿，直径4.0～8.5 cm，平均5.9 cm。23例全麻下行输尿管软镜钬激光肾盂旁囊肿切开内引流术。术中电子输尿管软镜观察集合系统与囊肿的解剖关系，在超声引导下用200 μm钬激光光纤向凸起的囊壁“十字”切开1.5～2.0 cm，囊腔内留置双J管内引流。记录手术成功例数以及术后症状缓解、囊肿变化和并发症情况。结果 23例手术均成功。手术时间17～50 min，平均28.0 min。腰痛者症状缓解，合并结石者术后复查无残留，肾功能减退者手术后肾小球滤过率（GFR）有所改善。1例术中出现肾被膜下积液，保留双J管引流24 h后消失。随访12～64个月，平均28.0个月。15例囊肿消失，8例直径较术前缩小 > 1/2。23例均未出现囊肿感染、血肿、复发和癌变等。结论 超声引导下经尿道输尿管软镜钬激光切开内引流术治疗肾盂旁囊肿是安全、有效的，且微创、并发症少，值得临床推广。

Abstract:

Objective To explore the safety and effectiveness of ultrasound-guided transurethral flexible ureteroscopic holmium laser incision and internal drainage for parapelvic cysts.Methods Clinical data of patients with parapelvic cysts from November 2014 to March 2019 were collected. There were 23 cases including 12 male and 11 female patients. The age ranged from 33 to 75 years, with an average of 58.3 years. There were 6 cases of flank pain, and the others were found on physical examination. There were 5 cases with ipsilateral kidney stones, 16 cases with ipsilateral hydronephrosis, and 1 case with impaired renal function. Preoperative ultrasound and contrast-enhanced CT of the urinary system suggest a parapelvic cyst, 4.0 to 8.5 cm in diameter, with an average of 5.9 cm. All the 23 patients underwent ureteroscopic holmium laser incision and internal drainage under general anesthesia. During the operation, the flexible ureteroscope was used to observe the anatomical relationship between the collection system and the cyst. Under the guidance of ultrasound, a 200-micrometer holmium laser fiber was used to make an incision of 1.5～2.0 cm on the cyst wall and double J stent was placed in the cyst cavity for drainage. The number of successful operations, postoperative symptom relief, cyst changes, and complications were analyzed.Results All the 23 cases were successful received operations. The operative time was 17～50 minutes, with an average of 28.0 minutes. Symptoms of patients with flank pain were relieved, those with stones had no residue on postoperative examination, and those with renal impairment had improved GFR after surgery. 1 case had renal subcapsular effusion during operation and drained off by the double J stent after 24 hours. The follow-up time was 12 to 64 months (average 28.0 months). Results of follow-up showed that in 15 cases, cyst disappeared, and in 8 cases that the diameter of the cyst reduced by more than half. All the 23 cases had no cyst infection, hematoma, recurrence, and canceration.Conclusion Ultrasound-guided transurethral flexible ureteroscopic holmium laser incision and internal drainage for parapelvic cysts is safe and effective, with minimal invasion and complications, and is worthy of clinical promotion.