一次性电子输尿管软镜同期治疗上尿路结石合并肾盂旁囊肿的初步观察（附13例报告）

Preliminary observation of simultaneous treatment of upper urinary tract calculi and parapelvic cysts by disposable electronic flexible ureteroscopy (13 cases)

摘要:

目的 初步探讨一次性电子输尿管软镜同期治疗13例上尿路结石合并肾盂旁囊肿的安全性和有效性。方法 回顾性分析2018年12月－2021年12月该院收治的13例肾孟旁囊肿合并上尿路结石患者的临床资料。13例患者术前均预置双J管5～7 d，一次性电子输尿管软镜置入肾盂，确定结石和囊肿位置后，先用200 μm钬激光光纤将结石击碎成粉末状，较大的结石碎块用套石篮取出，然后再用光纤切开集合系统微凸起的肾盂旁囊肿壁，使囊腔和集合系统相通，留置双J管，近端置于切开的囊肿内，引流4周，观察手术时间、出血量和并发症等情况。结果 13例患者手术均一次性成功，手术时间19～46 min，平均（28.6±10.2）min。无继发出血、严重感染和尿外渗等并发症。1例孤立肾肾盂旁囊肿术后29 h无尿，经治疗后，36 h尿量恢复正常，复查肌酐和尿素氮均正常。术后随访3～36个月，平均（12.6±9.8）个月，上尿路结石完全清除，无囊肿复发。结论 一次性电子输尿管软镜下钬激光治疗上尿路结石合并肾盂旁囊肿，损伤小，并发症发生率低，疗效确切，手术安全。

Abstract:

Objective To investigate the safety and efficacy of disposable electronic flexible ureteroscopy simultaneous treatment of 13 cases of upper urinary tract stones and parapelvic cysts.Methods Retrospectively analysis of the clinical data of 13 patients with parapelvic cyst combined with upper urinary tract stones from December 2018 to December 2021. 13 patients were presetting the double J stent for 5 ~ 7 d before surgery, and the disposable electronic flexible ureteroscopy was placed in the renal pelvis to determine the location of the stones and cysts, the stones were crushed into powder with a 200 μm holmium laser fiber, and the larger stone fragments were removed with a stone basket, and then the micro-raised parapelvic cyst wall of the collection system was cut with the optical fiber, so that the cystic cavity and the collection system were communicated. Indwelling double J stent, the proximal end was placed in the incised cyst for 4 weeks to drain, and the operation time, bleeding amount, complications were analyzed.Results All the 13 patients had successful one-time surgery, with an operation time of 19 ~ 46 min and an average of (28.6 ± 10.2) min. There were no complications such as secondary bleeding, severe infection, urinary leakage, etc. One isolated renal parapelvic cyst had no urine for 29 h, and the urine output returned to normal 36 h after treatment, and the creatinine and urea nitrogen were normal. Postoperative follow-up was 3 ~ 36 months, with an average of (12.6 ± 9.8) months, and the upper urinary tract stones were completely cleared without cyst recurrence.Conclusion Disposable electronic flexible ureteroscopy simultaneous treatment of upper urinary tract stones with parapelvic cysts is less traumatic, less complications, more effective, and safer.