超声引导下逆行输尿管软镜手术腔内治疗肾囊性疾病的安全性和疗效  

Safety and efficacy of ultrasound guided retrograde intrarenal surgery in the treatment of renal cyst

作　　者：塔来提·塔依尔 阿不力孜·司马义[1] 雷鹏[1] 艾合买提·艾买尔[1] 张小安[1] 亚力坤·阿里木[1] TALAITI Tayier;ABULIZI Simayi;LEI Peng;AIHEMAITI Aimaier;ZHANG Xiaoan;YALIKUN Alimu(Urological Center,People s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院泌尿中心,新疆乌鲁木齐830001

出　　处：《现代泌尿外科杂志》2022年第7期552-555,共4页Journal of Modern Urology

摘　　要：目的探讨超声引导下逆行输尿管软镜手术(RIRS)在肾囊性疾病治疗中的安全性及疗效。方法回顾性分析2017年12月-2021年4月入住新疆维吾尔自治区人民医院泌尿外科并行输尿管软镜钬激光开窗内引流手术治疗的26例肾囊肿患者的临床资料,男性14例,女性12例;年龄43~64岁,平均(49.8±6.9)岁;囊肿直径40~73 mm,平均(52.8±9.6)mm;其中伴肾上盏局限性积水1例、轻度肾积水1例、合并肾结石4例。术后2个月取出D-J管并于2周后复查1次泌尿系超声及双肾CT扫描,此后每3个月复查1次泌尿系超声、每6个月复查1次双肾CT扫描至随访时间满24个月。结果所有患者均行经尿道输尿管软镜肾囊肿钬激光开窗内引流术,10例(38.5%)行一期手术,16例(61.5%)行二期手术;手术时间15~90 min,平均(33.5±16.5)min;1例术中未找到囊肿,1例多发囊肿患者切开第1个囊肿后发现囊腔内临近的第2个囊肿壁并同时行开窗引流;术后住院时间1~4 d,平均(1.85±0.78)d;术后均为ClavienⅠ级并发症,包括术后腰痛2例、术后发热1例、肾周血肿1例,经保守治疗血肿稳定;术后随访3~24个月,囊肿消失14例、明显缩小10例、无变化2例(其中1例未找到囊肿)。结论输尿管软镜钬激光肾囊肿开窗引流术安全、有效,术后恢复快,复发率低,可成为肾盂旁囊肿及肾内型囊肿的理想治疗方式之一。Objective To evaluate the safety and efficacy of ultrasound guided retrograde intrarenal surgery(RIRS)in the treatment of renal cyst.Methods The clinical data of patients with renal cyst treated with RIRS during Dec.2017 and Apr.2021 were retrospectively analyzed,including 14 male and 12 female,with a mean age of(49.8±6.9)years(range 43-64 years).The mean size of cysts was(52.8±9.6)mm(range 40-73 mm).Complicated upper calyces hydronephrosis was observed in 1 case,mild hydronephrosis in 1 case,and renal calculi in 4 cases.The D-J tube was removed 2 months after operation.Urinary ultrasound and dual renal CT scan were re-conducted 2 weeks later.After that,urinary ultrasound was performed every 3 months and dual renal CT scan every 6 months until the last follow-up of 24 months.Results All cases received RIRS,10(38.5%)patients underwent one-stage surgery,and 16(61.5%)two-stage surgery.The mean operative time was(33.5±16.5)min(range 15-90 min).Cyst was not found in 1 case.In 1 patient with multiple cysts,after the incision of the first cyst,the cyst cavity was found adjacent to the wall of a second cyst,and fenestration drainage was performed simultaneously.The mean postoperative hospital stay was(1.85±0.78)days(range 1-4 days).Surgical complications occurred in 4 cases,including 1 with fewer(ClavienⅠ),2 with back pain and 1 with renal hematoma(ClavienⅠ).During the follow-up of 3-24 months,cysts disappeared in 14 cases,became significantly smaller in 10 cases,and remained unchanged in 2 cases.Conclusion Retrograde intrarenal surgery is safe and effective in the treatment of renal cyst,with advantages of quick recovery and low recurrence rate.It can be an alternative treatment for parapelvic cyst and intrarenal cyst.

关 键 词：肾囊肿 输尿管软镜 钬激光 腔内手术 肾囊肿开窗引流 逆行输尿管软镜手术 

分 类 号：R692.9[医药卫生—泌尿科学]