一次性输尿管软镜治疗肾盂旁囊肿合并同侧继发肾结石

Disposable flexible ureteroscopy for the treatment of ipsilateral parapelvic cyst with secondary renal calculi

目的探讨一次性输尿管软镜同时行钬激光碎石取石术和肾囊肿内切开引流术治疗肾盂旁囊肿合并同侧继发性肾结石的临床治疗效果。方法2019年9月至2023年2月,在首都医科大学附属北京同仁医院使用一次性输尿管软镜对58例肾盂旁肾囊肿合并同侧肾结石患者行钬激光碎石取石术和肾囊肿内切开引流术治疗。分别于术后1、2、6、12个月于门诊随访超声和计算机断层扫描检查以检测残结石及肾囊肿复发情况。结果患者平均年龄分别为(39.3±15.6)岁。肾盂旁囊肿平均大小为(5.8±1.9)cm,包括54例BosniakⅠ类和4例BosniakⅡ型肾囊肿患者,肾结石的平均大小为(13.3±5.5)mm,平均手术时间为(33.4±12.1)min,平均住院时间为(2.3±0.7)d,并发症包括3例患者短暂发热(>38℃)和1例患者明显出血,无严重并发症。手术后1个月和2个月的无结石率分别为94.1%(53例)和98.3%(57例),术后1年随访期间,囊肿复发率为6.9%(4例),结石复发率为5.2%(3例)。结论一次性输尿管软镜下行钬激光碎石取石术和肾囊肿内切开引流术同时治疗肾结石和肾盂旁囊肿是安全有效的,清石率令人满意,囊肿复发率低。

Objective To assess the clinical effect of holmium laser lithotripsy combined with intrarenal renal cyst incision and drainage in the treatment of parapelvic renal cysts combined with ipsilateral secondary kidney stones by disposable ureteroscope.Methods From September 2019 to February 2023,58 patients in Beijing Tongren Hospital,Capital Medical University with parapelvic renal cysts combined with ipsilateral secondary kidney stones were treated with holmium laser lithotripsy and intrarenal incision and drainage of renal cysts using disposable ureteroscope.At 1,2,6 and 12 months after surgery,the patients were followed up by ultrasound and/or computed tomography(CT)to detect the recurrence of residual stones and renal cysts.Results The mean age of the patients was(39.3±15.6)years.The average parapelvic cyst size was(5.8±1.9)cm,including 54 Bosniak ClassⅠpatients and 4 Bosniak classⅡpatients.The average size of kidney stones is(13.3±5.5)mm.The mean operation time was(33.4±12.1)min,and the mean length of stay was(2.3±0.7)d.Complications included transient fever(>38℃)in 3 patients and significant bleeding in 1 patient.There were no serious complications.The stone-free rates at 1 month and 2 months were 94.1%(53 cases)and 98.3%(57 cases),respectively.During 1 year of follow-up,the recurrence rate of cysts and stones was 6.9%(4 cases)and 5.2%(3 cases)respectively.Conclusions This study shows that holmium laser lithotripsy combined with intrarenal renal cyst incision and drainage in the treatment of parapelvic renal cysts combined with ipsilateral secondary kidney stones by disposable ureteroscope are safe and effective in the treatment of parapelvic cysts combined with kidney stones,with satisfactory stone removal rate and low recurrence rate of cysts.