经自然腔道内镜手术内切开引流治疗肾盂旁囊肿

Internal drainage of parapelvic cyst by pure natural orifice transluminal endoscopic surgery

目的探讨经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)切开引流治疗肾盂旁囊肿的安全性及有效性。方法选取2016年4月至2017年1月于徐州市中心医院泌尿外科就诊的肾盂旁囊肿患者6例,术前均经CT及IVU确诊,利用输尿管软镜进入肾盂,230μm钬激光圆形切除囊壁,使囊腔开窗引流至肾盂。采用配对t检验比较术前、术后囊肿最大直径的差异。结果 6例患者均顺利完成手术并出院,未发生严重并发症。手术时间40~80 min,平均(56.22±15.79)min;住院时间2~4 d,平均(2.56±1.05)d;术后随访3~6个月,平均(4.12±0.56)个月。5例患者的囊肿显著缩小(超过1/2),1例囊肿消失;术前和术后囊肿直径分别为4.50~8.70 cm、平均(6.95±1.83)cm和0~2.5 cm、平均(1.42±0.86)cm,差异有统计学意义(P<0.01)。结论通过NOTES技术进行肾盂旁囊肿内切开引流,手术简单微创,安全可行、近期疗效确切,且具有恢复快、患者依从性高等优点,适合肾盂旁囊肿的治疗。远期疗效尚需进一步随访评估。

Objective To probe the safety and effectiveness of internal drainage of parapelvic cystby pure natural orifice transluminal endoscopic surgery （ NOTES）. Methods From Apr. 2016 to Jan.2017, 6 patients with parapelvic cyst confirmed by CT and IVU in Xuzhou Central Hospital were enrolled inour research. Flexible ureteroscope was introduced into renal pelvis, and then the feeble cyst wall wasvaporized by Ho-YAG to internal drain the cyst. The cyst diameters before and after operation was comparedthrough paired t test. Results All procedures were completed successfully and patients discharged smoothly without serious complications. The operation time was from 40 to 80 min, mean （56. 22 ±15.79） min,the period of hospitalization was from 2 to 4 days, （2. 56 ± 1.05）days. During 3-6 months follow-up,（4. 12 ± 0. 56） months. It had been found that the diameter of cysts decreased significantly in 5 cases, and the otherone had disappeared. The differences were statistical significance 4. 50-8. 70 cm, （6. 95 ±1. 83） cm vs 0-2. 5 cm,（ 1.42 ± 0. 86） cm （P 〈0.01） . Conclusions Internal drainage of parapelvic cyst by NOTES is simple,minitraumatic,safe and short-term effective,and has the advantages of recovery rapidly and highcompliance of patient,it is a alterative choice to treat parapelvic cyst. The long-time efficacy needs furtherfollow-up evaluation.