侧卧位"Φ"字切除法在经皮肾镜等离子肾囊肿去顶术中的应用  

Application of "Φ-shaped" resection in lateral position in percutaneous nephroscope plasma electrode deroofing of renal cysts

作　　者：于忠英[1] 李金雨[1] 赵力[1] 朱显钟 许伟杰 张汉荣 罗辉 庄园丽 Yu Zhongying;Li Jinyu;Zhao Li;Zhu Xianzhong;Xu Weijie;Zhang Hanrong;Luo Hui;Zhuang Yuanli(Department of Urology,the Affiliated Southeast Hospital of Xiamen University(No.909 Hospital),Zhangzhou 363000,China)

机构地区：[1]厦门大学附属东南医院(联勤保障部队第909医院)泌尿外科,福建漳州363000

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第1期63-66,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：第九〇九医院青年苗圃基金(18Y007)。

摘　　要：目的探讨侧卧位"Φ"字切除法在经皮肾镜等离子肾囊肿去顶术中的效果。方法回顾性分析2017年2月至2021年5月在厦门大学附属东南医院泌尿外科手术治疗的31例背侧肾囊肿患者资料。手术取侧卧位,彩超引导穿刺针刺入囊肿腔内,置导丝,退针,置入22 F剥皮鞘及经皮肾镜,探查囊腔是否与肾盂相通并辨识囊壁与肾实质的交界线,置入等离子电极,分别向12及6点钟方向切割囊壁至交界或囊壁增厚处;自6点钟沿交界线附近向左弧形挑拨切割至12点方向,同法切割右侧囊壁,总体切割路径呈"Φ"字型。不进一步游离囊壁,以穿刺点左侧囊壁为钳夹部位,边旋转边将左半边囊壁牵拉出体外,同法处理右侧。检查有无出血,必要时电凝止血。留置引流管退鞘。术后复查囊肿腔较术前缩小50%以上为有效。结果1例术中修正诊断为肾盏憩室,余30例患者手术均按计划完成,手术时间15~52 min,无并发症。随访3~12个月,未见明显复发。结论经皮肾镜等离子肾囊肿去顶术治疗背侧单纯性肾囊肿的过程中采用侧卧位改良"Φ"字切除法安全、有效,便于麻醉管理,可完整取出手术标本。Objective To explore the safety and effectiveness of the"Φ-shaped"resection in lateral position in percutaneous nephroscope plasma electrode deroofing of renal cysts.Methods A retrospective analysis of the data of 31 patients with dorsal renal cysts treated in the Affiliated Southeast Hospital of Xiamen University from February 2017 to May 2021.Patients took the lateral position,surgeons used color Doppler ultrasound to guide the puncture needle into the cyst cavity,placed the guide wire,withdrew the needle,inserted the 22 F peel-away sheath and percutaneous nephroscope,then checked whether the cyst cavity was connected to the renal pelvis and identified the cyst wall and renal parenchyma plasma electrodes were inserted into the boundary line of the sac,and the capsule wall was cut to the junction or the thickening of the sac wall at 12 and 6 o’clock respectively.From 6 o’clock,it was cut to the 12 o’clock direction along the left arc along the boundary line,the same method cut the right side of the capsule wall,the overall cutting path was in the shape of"Φ".Without further dissociating the cyst wall,the left side of the puncture point was taken as the clamping site,and the left half of the cyst wall was pulled out of the body while rotating,and the right side was treated in the same way.Check for bleeding,if necessary,electrocoagulation to stop the bleeding.The indwelling drainage tube was unsheathed.Postoperative reexamination of the cyst cavity was more than 50%smaller than before meaned the operation was effective.Results One case was diagnosed as renal calyx diverticulum during the operation.The operations of the remaining 30 patients were completed as planned.The operation time was 15-52 min without complications.Followed up for 3-12 months,there was no obvious recurrence.Conclusions During the treatment of dorsal simple renal cyst with percutaneous nephroscope plasma,the modified"Φ-shaped"resection method in lateral position is safe and effective,and it is convenient for anesthesia management.The

关 键 词：侧卧位 "Φ"字切除法 经皮肾镜 等离子 肾囊肿 

分 类 号：R699.2[医药卫生—泌尿科学]