一期末段可弯硬性输尿管肾镜钬激光肾盂旁囊肿切开引流术的疗效分析

Clinical efficacy of tip-flexible ureterorenoscope with holmium laser for one-stage management of parapelvic cyst

目的探讨一期末段可弯硬性输尿管肾镜钬激光一期肾盂旁囊肿切开引流术的安全性和有效性。方法回顾性分析2016年2月至2018年8月广东省第二人民医院收治的26例肾盂旁囊肿患者的临床资料。男15例,女11例;年龄32~68岁,平均53.5岁。体检发现7例;腰腹部酸胀不适19例,其中2例有肉眼血尿;1例合并2型糖尿病,3例合并高血压。单侧单发肾盂旁囊肿24例,双侧单发肾盂旁囊肿2例;26例中一侧单发肾盂旁囊肿伴对侧单纯肾囊肿4例,一侧单发肾盂旁囊肿伴同侧肾结石2例。囊肿最大径为3.4~5.6 cm,平均4.8 cm。26例均全麻下行末段可弯硬性输尿管肾镜钬激光肾盂旁囊肿切开引流术,直视下经尿道置入末段可弯硬性输尿管肾镜(如不能直接上镜,则放置双J管1~2周后再行处理),观察输尿管情况,以及集合系统与肾盂旁囊肿的解剖关系。用200 μm钬激光光纤向集合系统微凸起的囊壁开窗引流,开窗直径1.5~2.0 cm,使囊腔和集合系统交通,留置双J管引流。分析一期手术患者的手术时间、住院时间、手术出血量,及术后并发症、临床症状缓解情况。结果26例一期上镜23例,上镜成功率88.5%。3例一期上镜未成功者,留置双J管2周后,行二期手术。23例一期手术患者单侧肾盂旁囊肿处理时间11~25 min,平均17.2 min。无术中出血病例,术中、术后均无严重并发症。术后随访3~30个月,平均17.0个月,22例囊肿消失,1例囊肿较术前缩小>1/2,未见囊肿复发,其中19例有腰痛患者术后腰痛症状均消失,3例高血压患者血压恢复正常,2例血尿消失。2例合并同侧肾结石患者术后3个月复查CT未见结石残留。患者未出现囊肿复发、感染、血肿、癌变等。结论一期末段可弯硬性输尿管肾镜钬激光肾盂旁囊肿切开引流术创伤小、并发症少、疗效确切,手术安全、有效。

Objective To evaluate the efficacy and safety of tip-flexible ureterorenoscope (tf-URS) with holmium laser for one-stage management of parapelvic cyst. Methods The clinical data of 26 patients treated with tf-URS incision and drainage using holmium laser from February 2016 to August 2018 were reviewed. The study were including 15 male and 11 female patients, ranging from 32 to 68 years old, with an average of 53.5 years old. There were 24 cases of unilateral single renal parapelvic cyst and 2 cases of bilateral single renal parapelvic cyst. There were 4 cases in 26 cases with unilateral single renal parapelvic cyst and contralateral single renal cyst, 2 cases with unilateral single renal parapelvic cyst and ipsilateral kidney of stones.The diameter of parapelvic cyst was 3.4-5.6 cm, average 4.8 cm. All patients had undergone holmium laser endo-decortication of parapelvic cyst by tf-URS. With general anesthesia, tf-URS accessed pelvis retrogradely and decorticated parapelvic cyst with 200 μm Holium laser to drainage the cyst to pelvis.If the tf-URS was not placed successfully for the first time, Double-J tubes were retained for 1-2 weeks before treatment. The operative time, hospitalization time, blood loss, postoperative complications and clinical symptoms were collected and analyzed. Results The one-time access success rate of insertion of tf-URS was 88.5%(23/26). All operations were successful without severe complications.The average time of operation was 17.2 min, ranging from 11 to 25 min.In 3-30 months follow-up, the cysts disappeared in 22 patients and reduced by more than one half in 1 patients. Flank pain relieved in 19 patients. Conclusions Holmium laser endo-decortication of parapelvic cyst by tf-URS could be a simple, minimally invasive, safe and effective method for parapelvic cyst, which is worthy of further promotion and application in clinical practice.