输尿管软镜下寻找肾盂旁囊肿失败时辅以超声的应对策略  

Strategies for applying ultrasound when flexible ureteroscopy failed to find parapelvic cysts

作　　者：闫昆吾 田晓菲[1] 孟娜[1] 刘文瞻[1] 路志民[1] 郭明涛[1] 肖波[1] YAN Kunwu;TIAN Xiaofei;MENG Na;LIU Wenzhan;LU Zhimin;GUO Mingtao;XIAO Bo(Department of Urology,Handan First Hospital,Handan,Hebei,056002,China)

机构地区：[1]邯郸市第一医院泌尿外科,河北邯郸056002

出　　处：《临床泌尿外科杂志》2022年第3期229-233,共5页Journal of Clinical Urology

摘　　要：探讨输尿管软镜下寻找肾盂旁囊肿失败时应用超声的临床应对策略。回顾性分析2018年4月-2021年1月邯郸市第一医院收治的23例行输尿管软镜下肾盂旁囊肿切开内引流术患者的临床资料,其中12例患者在软镜直视下成功寻找囊壁并切开内引流(常规组);11例患者在软镜直视下寻找囊壁失败后辅以术中超声寻找囊肿(超声组)。选择输尿管软镜靠近并接触可疑囊壁后在实时超声定位下选择囊肿受压变形最大处作为囊壁最薄处行开窗内引流,同时术中超声实时引导和监测,囊肿开窗后留置双J管一端于囊腔内持续引流。评估两组手术成功率、手术时间、术后并发症及术后随访情况。结果发现23例患者先行常规输尿管软镜时的手术成功率为52.2%(12/23),对其中失败的患者辅以术中超声的手术成功率为100.0%(11/11),经超声补救措施后所有患者均顺利完成囊肿内引流手术。常规组手术时间17~34 min,平均26.2 min;超声组手术时间25~56 min,平均38.9 min;两组手术时间比较差异有统计学意义(P<0.05)。所有患者术后随访3~12个月,常规组中8例患者未见明显囊肿,4例患者可见囊肿明显缩小(直径<2 cm);超声组中6例患者未见明显囊肿,5例患者可见囊肿明显缩小;两组囊肿复发比较差异无统计学意义(P>0.05)。因此,术中输尿管软镜直视下寻找肾盂旁囊肿失败时辅以超声定位可作为一种补救性措施,该方法具有成功率高、创伤小和安全性高的优势。Strategies for applying ultrasound when simple flexible ureteroscopy failed to find the parapelvic cysts in surgery were investigated.From April 2018 to January 2021,the clinical data of 23 patients admitted to Handan First Hospital with parapelvic cystic disease were retrospectively analyzed.Twelve in the conventional group underwent flexible ureteroscopy to find the cystic wall and successful internal drainage,while 11 in the ul-trasonography group were treated with flexible ureteroscopy under ultrasound localization after a simple flexible ureteroscope failed to find the cystic wall,The flexible ureteroscopy was selected to contact the suspected cyst wall,and then the cyst was selected under real-time ultrasound localization at the point of maximum pressure,which was served as the thinnest part of the cyst wall for drainage and was guided by intraoperative ultrasound in real-time.The collection system could be communicated with the sac wall and indwelling the double J tube drain-age was performed.The operation time,perioperative complications,recurrence rate were evaluated.It was found that the success rate of the procedure was 52.2%(12/23)in 23 patients when a simple flexible ureteroscope was performed first,after the addition of intraoperative ultrasound,the success rate of the procedure in patients with.the failed simple flexible ureteroscopic operation was 100.0%(11/11).The operations were successfully accom-plished in all cases after remedial measures were taken.The operation time in the conventional group was 17-34 minutes.with an average of 26.2 minutes.And the operation time in the ultrasonography group was 25-56 mi-nutes,with an average of 38.9 minutes.The difference in operation time between the two groups was statistically significant(P<0.05).All patients were followed up for 3-12 months.In the conventional group.the cysts dis-appeared in 8 patients and were significantly reduced in the other 4 patients.In the ultrasonography group,the cysts disappeared in 6 patients and were significantly reduced i

关 键 词：输尿管软镜 肾盂旁囊肿 超声 钬激光 内引流 

分 类 号：R692[医药卫生—泌尿科学]