经尿道输尿管镜下钬激光治疗儿童输尿管囊肿13例报告

Transurethral treatment of children ureterocele with holmium-laser under ureteroscope(Report of 13 cases)

目的：探讨经尿道输尿管镜下钬激光治疗儿童输尿管口囊肿的疗效。方法：2005年1月～2007年1月对13例14侧儿童输尿管囊肿采用经尿道输尿管镜下钬激光治疗。对于直径小于1cm的囊肿，以钬激光从管口切开直到囊肿根部；而对于直径大于1cm但小于3cm的囊肿，则于囊肿膨胀时将囊肿低位切开并切除下1／3囊肿壁，使引流通畅，并使剩余的近侧囊肿成一活瓣样结构，防止输尿管尿液反流。结束手术前检查囊肿在输尿管喷尿期不再膨胀。如果仍存在膨胀，则说明切除量不够，可再切除部分囊肿壁。对于合并囊内结石者，将囊肿切开后用钬激光直接行碎石治疗，然后将碎石冲出。结果：所有患者均一次成功。手术时间20～70min，平均30min。无输血与死亡。住院5～12天，平均7天。13例患者术后病理检查报告均示输尿管口囊肿。患者血尿、腰腹疼痛及排尿困难均消失。13例均获得随访，随访时间6～24个月。经B超及膀胱造影等检查证实无复发，无输尿管尿液反流，无输尿管开口狭窄。7例7侧肾积水消失，1例两侧肾积水明显减轻。结论：对于直径小于3cm的儿童输尿管囊肿，采用经尿道输尿管镜下钬激光治疗疗效满意，值得推广应用。

Objective：To discuss the therapeutic effect of holmium-laser on children ureterocele under ureteroscope. Methods： 13 cases were treated with holium-laser for 14 sites from January 2005 to January 2007. Different operation methods were used due to different sizes. Results： All cases were successfully conducted. The mean operation time was 30 minutes. There was no transfusion and death case. There was no recurrence and reflux postoperative case. Conclusions： Holmium-laser has good effect on children ureterocele whose diameter is less than 3 cm and should be widely spread.