输尿管镜钬激光治疗儿童输尿管末端囊肿的疗效分析

Analysis of therapeutic effect of ureteroscopic holmium laser treat for ureter cyst of children

目的：探讨输尿管镜钬激光治疗儿童输尿管末端囊肿的疗效。方法回顾性分析2010年3月至2014年3月本院22例儿童输尿管末端囊肿临床资料，均经B 超、泌尿系CT、静脉尿路造影、膀胱逆行造影检查确诊，并接受输尿管镜钬激光囊肿切开术。22例患儿年龄3个月至15岁，平均3.6岁，其中女性15例（68.2％），男性7例（31.8％）；左侧9例（40.9％），右侧11例（50.0％），双侧2例（9.1％）；囊肿开口于膀胱内20例（90.9％），开口于膀胱颈尿道内口2例（9.1％）；16例（72.7％）合并患侧肾积水或者输尿管扩张，7例（31.8％）合并重复肾畸形，且均为上下位肾输尿管Y形融合并以末端囊肿开口于膀胱内，4例（18.2％）伴有膀胱输尿管反流，1例（4.5％）合并输尿管末端结石，13例（59.1％）合并尿路感染；均行输尿管镜钬激光囊肿切开术，手术时间为14～46 min，平均（28±10）min，术中出血量2～10 mL，住院时间2～5 d，平均（3.1±1.0）d。结果术后21例随访，1例失访，随访时间为3～31个月，20例未见输尿管囊肿复发，10例尿路感染症状完全消失，12例肾积水或者输尿管扩张得到明显改善，1例合并结石的未见复发，1例出现膀胱输尿管反流加重而行输尿管膀胱再植术。结论输尿管镜钬激光治疗儿童输尿管末端囊肿操作简便，创伤小，手术时间短，恢复快，并发症少，可作为首选治疗方式；对于严重膀胱输尿管反流，异位输尿管开口的重复肾患儿，术前需要做充分评估，以减少再次手术的风险。

Objetive To evaluate the effect of ureteroscopic holmium laser treat the ureter cyst of children. Methods The clinical data of 22 cases of ureter cyst patients for children from March 2010 to March 2014 were analyzed retrospectively.These patients are receive ultrasound,urinary tract CT,Intravenous urinary tract imaging examination,Bladder retrograde urethrography before diagnosis of ureter cyst,and then accept the operation of ureteroscopy holmium laser incision.The age of 22 cases from 3 months to 15 years old,which girl 15 cases （68.2%）and boy 7 cases （31.8%）;9 cases （40.9%）on the left side of,11cases （50.0%） on the right side,and 2 cases （9.1%）with double side;20 cases （90.9%）of cyst open in the bladder,2 cases（9.1%）of cyst open in the bladder neck of internal urethral orifice;16 cases （72.7%）of hydronephrosis or ureterectasia;7 cases （31.8%）patients with duplex kidney,both these ureter of duplex kidney are combined with Y shape and last opening in the bladder for the end of ureter cyst;4 cases （18.2%）with Vesicoureteral reflux,1case （4.5%）complicated stone,13 cases （59.1%）children with urinary tract infections.All patients received the operation of ureteroscopy holmium laser incision.Operative time was 14～46 min,average 28 ±10 min,blood loss was about 2～10 mL,hospitalization time was 2 to 5 days,with an average was 3.1±1.0 days. Results 21 cases were followed after surgery,one patient was lost,follow-up period from 3 to 31 months.The followed children were review ultrasound and urine routine examination.20 cases without recurrence of ureterocele,10 cases of children the symptoms of recurrent urinary tract infection completely disappeared,12 patients with hydronephrosis or ureterectasia has been significantly improved,and 1 case combined stone without recurrence after operation,One patient perform ureteral reimplantation because of severe vesicoureteral reflux. Conclusion Holmium laser treatment for children ureterocele has many advantages：easy to operate,small trauma,shorten operation time,accelerate postoperative recovery ,reduce complications,can be used as the first treatment.But for the children of severe vesicoureteral reflux or ectopic ureter opening of duplex kidney,the risk assessment need to be fully preoperatively before surgery in order to reduce the risk of reoperation.