局麻下经皮肾钬激光肾囊肿去顶术的临床研究

Clinical research of deroofing of renal cysts by percutaneous technique with holmium laser under local anaesthesia

目的:探讨局麻下经皮肾钬激光肾囊肿去顶术的安全性和有效性。方法:回顾性分析2018年3月~2019年5月我院行局麻经皮肾钬激光肾囊肿去顶术27例患者的临床资料,其中男17例,女10例;年龄52~85岁,平均(68±10)岁;左侧15例,右侧12例;囊肿大小4.3~8.9cm,平均(6.2±1.5)cm。所有患者术前完善CTU检查,诊断为单纯性肾囊肿。手术采用俯卧位,腹部垫15cm软枕,彩超定位囊肿后,穿刺点及通道用5~10 mL 2%利多卡因局部麻醉,在超声定位下用经皮肾镜穿刺针穿刺进入囊肿,可见囊液流出,经穿刺针留置金属导丝至囊腔,行“一步法扩张”建立F18~20经皮肾通道,置入F8/9.8输尿管镜探查囊腔和囊壁与肾实质分界线,直视下退鞘至囊壁,见囊壁与周围脂肪界限,助手用取石钳夹取囊壁,旋转180~360°并牵引至通道鞘内,用钬激光(单发能量0.6~1.0J,频率25~40Hz)将囊壁逐块切除至合适大小并取出,再次探查囊腔边界无明显出血后,留置肾周引流管并退鞘。术后1d复查泌尿系CT,3~9个月复查泌尿系彩超。囊腔大小比术前减小50%和(或)症状缓解为有效。结果:所有手术均成功完成,手术时间27~56min,平均(37±7)min;术中疼痛评分0~4分,平均(1.2±1.3)分。术前与术后血红蛋白[(14.3±1.0)g/L vs.(14.2±0.9)g/L,P>0.05]。术中及术后未出现大出血、感染性发热、尿瘘、周围脏器损伤等并发症。术后1d泌尿系CT未见明显肾周积液或积血等,术后2d内拔除引流管并出院。术后病理均提示为单纯性肾囊肿。随访3~9个月,复查泌尿系彩超未见囊肿复发。结论:对<10cm近背侧的外生型单纯性肾囊肿,局麻下经皮肾钬激光肾囊肿去顶术安全、有效。

Objective:To access the safety and efficacy of holmium laser deroofing of renal cysts by percutaneous technique under local anaesthesia.Method:From March 2018to May 2019,27cases(17males,10females)had been treated with holmium laser deroofing of renal cysts by percutaneous technique under local anaesthesia were enrolled,aged 52-85y(mean aged 68±10y),including 15in left side and 12in the right.The size of renal cysts were from 4.3to 8.9cm(mean 6.2±1.5cm).All patients were diagnoses simple renal cysts evaluated by enhanced urinary CT scan.Patients were placed in the prone position with a 15cm soft pillow under abdomen.Local anaesthesia with 5-10mL 2%lidocaine and percutaneous puncture into the cyst with a needle were accomplished under the guidance of ultrasound,and then a metal guidewire was inserted.A 18-20Fr percutaneous tract was built into the cyst by standard percutaneous technique steps.8/9.8Fr rigid ureteroscopy was input to detect the cyst cavity and the border between kidney and wall,then return the tract to cyst wall under vision.After differentiating and grasping the cyst wall,the assistant rotated the grasping forcep about 180-360°and pulled it into the tract.The wall was incised by holmium laser(single power 0.6-1.0J,frequency 25-40Hz).Finally,aperinephric tube was placed for drainage.Unenhanced CT scan and urinary ultrasound were rechecked in 1day and 3-9months post-operation,respectively.Result:All operations were successful,operative duration was 27-56min(mean 37±7min),pain scored 0-4(mean 1.2±1.3).The mean hemoglobin pre-and post-operation was[(14.3±1.0)g/L vs.(14.2±0.9)g/L,P>0.05],respectively.No severe complications,such as serious bleeding,infective fever,urinary leakage,adjacent organ injury,had been found.There was not obvious hydroperinephrosis or hematocele 1day post-operation.The perinephric tube was removed,and patients were discharged with 2days.The overall postoperative pathology was simple renal cysts.All cases were followed for 3-9months,and no cyst recurrence was found by ultrasound.Conclusion:For<10cm near dorsal exogenous simple renal cysts,holmium laser deroofing by percutaneous technique under local anaesthesia is safe and effective.