B超定位“针辅助”经尿道输尿管软镜下钬激光内切开引流术治疗肾盂旁囊肿的临床研究

Clinical study of needle assisted retrograde intrarenal holmium-laser incision for pararenal cyst guided by B-ultrasound

摘要:

目的 探讨B超定位“针辅助”经尿道输尿管软镜下钬激光内切开引流术治疗肾盂旁囊肿的有效性和安全性。方法 回顾性分析2013年8月－2021年9月该院收治的33例肾盂旁囊肿患者的临床资料，术前由计算机体层摄影尿路造影（CTU）检查确诊，术中利用输尿管软镜进入肾盂，合并结石者，先行碎石取石，再用B超定位穿刺囊肿，激光沿穿刺针进出囊壁处烧灼囊壁，囊壁切开后，囊腔内留置双J管。结果 33例患者均顺利完成手术，手术时间11～72 min，平均（39.51±14.33）min；术后血红蛋白下降0～36 g/L，平均（13.88±5.12）g/L；术后住院1～8 d，平均（2.42±0.63）d；术后5例出现Clavien-DindoⅠ级并发症，1例出现Clavien-DindoⅡ级并发症，对症治疗后好转；双J管留置33～180 d，平均（63.42±12.88）d，拔管前，CT提示：18例囊肿完全消失，14例囊肿明显缩小，1例囊肿略缩小；合并肾积水者，积水均完全消失，14例合并结石者，12例完全排净，2例残留少许无意义结石。拔管后随访30～72 d，平均（34.28±7.11）d，再次复查CT，囊肿无复发或增大。结论 B超定位“针辅助”经尿道输尿管软镜下钬激光内切开引流术治疗肾盂旁囊肿，具有快速、创伤小、恢复快和疗效确切等优点，值得临床推广应用。

Abstract:

Objective To investigate the efficacy and safety of needle assisted retrograde intrarenal holmium-laser incision (RIR-HoLI) for pararenal cyst guided by B-ultrasound.Methods The clinical data of 33 patients with pararenal cyst treated from August 2013 to September 2021 were retrospectively analyzed. The diagnosis was made by computed tomography urography (CTU) before operation. During the operation, flexible ureteroscopic was used to enter the renal pelvis. For those with stones, lithotripsy was performed first, and then B-ultrasound was used to puncture the cyst. The laser burned along the puncture needle into or out of the cyst wall. After the cyst wall was cut, a double J stent was left in the cyst cavity.Results All the 33 operations were successfully completed. The operation time was 11 ~ 72 min, with an average of (39.51 ± 14.33) min. Hemoglobin decreased by 0 ~ 36 g/L, with an average of (13.88 ± 5.12) g/L. Postoperative hospital stay was 1~8 d, with an average of (2.42 ± 0.63) d; Clavien-Dindo grade Ⅰ complications occurred in 5 cases and Clavien-Dindo grade II complications occurred in 1 case, which improved after symptomatic treatment; The double J stent was retained for 33 ~ 180 d, with an average of (63.42 ± 12.88) d. Before extubation, CT showed that 18 cases of cysts disappeared completely, 14 cases were significantly reduced, and 1 case was slightly reduced; The hydronephrosis disappeared completely in all cases with hydronephrosis. In 14 cases with calculi, 12 cases were completely drained, and 2 cases remained a little meaningless calculi. The patients were followed up for 30 ~ 72 d after extubation, with an average of (34.28 ± 7.11) d. CT reexamination showed that there was no recurrence or enlargement of the cyst.Conclusion The needle assisted RIR-HoLI for pararenal cyst guided by B-ultrasound has the advantages of fast, small trauma, rapid recovery and accurate curative effect, and has the clinical significance of popularization.