经皮肾微造瘘钬激光腔内切开治疗肾需狭窄及闭锁

Treatment of renal calyceal stricture and atresia through antegrade percutaneous nephrostomy by Holmium laser

目的探讨经皮肾微造瘘钬激光腔内切开治疗肾盏狭窄及闭锁的方法及疗效。方法对68例经皮肾镜取石术中发现伴有肾盏狭窄或闭锁的患者采用钬激光腔内切开治疗。肾盏狭窄者59例，先以输尿管镜扩张，再以钬激光于盏颈的后外侧纵行切开盏颈黏膜直至接近肾实质处。肾盏闭锁者9例（均为穿刺肾盏），先根据术前IVU检查及术中穿刺肾盏情况对闭锁肾盏颈口作出大致判断，再以钬激光进行灼烧。术后留置肾造瘘7d，双J管6～8周。结果手术时间80～120min，平均90min。术后平均住院8（7～9）d。42例患者获随访，平均随访9（4～26）个月。临床症状改善明显、IVU显示内切开段造影剂通过良好，肾积水减轻38例；4例治疗失败者再次行经皮肾微造瘘钬激光腔内切开，1例随访13个月显示治疗成功，3例分别随访4、6、9个月，临床症状改善。结论经皮肾微造瘘钬激光治疗肾盏狭窄及闭锁具有微创（术中出血少，肾集合系统破坏小，肾功能受损轻）、住院时间短、疗效可靠、可重复进行等特点，可作为肾盏狭窄及闭锁患者微创治疗的首选。

Objective To evaluate the clinical efficacy and safety of Holmium laser in the treatment of calyceal stricture and atresia through antegrade percutaneous nephrostomy. Methods Antegrade percutaneous nephrostomy was performed in 68 patients with calyceal stricture and atresia through a rigid 8/9.8 F ureteroscope. The stricture and atresia was incised in a linear fashion by the Holmium laser with a 550 mm fiber. After completion of the incision, a double J ureteral stent was placed for 6--8 weeks and nephrostomy tube was kept for 7 days thereafter. Patients were then fol- lowed-up with IVU and/or ultrasound at 3--6 month intervals. Results The mean operative time was 90 rain, ranged from 80 to 120 min. The mean postoperative hospital stay was 8 d（7--9 d）. Hydronephrosis was significantly improved in 38 cases in an average follow up of 9 months （4 -- 26 months）. Repeated laser incision was performed to 4 treatment failures and all turned out to be successful. Conclusions The Holmium laser treatment through antegrade percutaneous nephrostomy for calyceal stricture and atresia has characteristics of minimal invasion, short hospital stay, good effi- cacy in short term and repeated cases. This procedure to be used as the first choice for patients with good renal function and mild hydronephrosis, especially accompanied with renal calculus.