经尿道输尿管软镜下钬激光内切开引流术治疗肾盂旁囊肿疗效分析  

Clinical effect of incision and drainage with Holmium laser under flexible ureteroscope in the treatment of parapelvic cysts

作　　者：冀家源 肖荆[1] 阮极盟 王翔宇 陈美元 杨洋 黎健发 崔腾 Ji Jiayuan;Xiao Jing;Ruan Jimeng;Wang Xiangyu;Chen Meiyuan;Yang Yang;Li Jianfa;Cui Teng(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Urology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京100050 [2]首都医科大学宣武医院泌尿外科,北京100053

出　　处：《国际外科学杂志》2024年第6期399-403,I0013,共6页International Journal of Surgery

基　　金：首都卫生科研发展专项(首发2024-1-4072);北京市通州区科技计划项目(KJ2023cx013)。

摘　　要：目的探讨经尿道输尿管软镜下钬激光内切开引流术治疗肾盂旁囊肿的安全性和有效性。方法回顾性分析2018年1月—2022年12月首都医科大学附属北京友谊医院收治的21例肾盂旁囊肿患者的临床资料,其中男性10例,女性11例;年龄36~72岁,平均(62.86±5.38)岁,中位数63.0岁;囊肿最大径为33~71 mm,平均(53.46±9.68)mm;其中伴同侧肾积水15例,合并同侧肾盂结石6例。纳入研究患者均采用经尿道输尿管软镜下钬激光内切开引流术治疗。术后1个月复查1次泌尿系超声并去除双J管,此后每6个月复查双肾CT至满12个月。随后每年定期复查双肾彩超,记录手术时间、术后住院时间、术后下床时间、术中出血量、肾囊肿有无复发及缩小情况等预后指标。结果21例成功行经尿道输尿管软镜下钬激光内切开引流术患者中,9例(42.9%)行一期手术,12例(57.1%)行二期手术,平均手术时间为(41.57±10.86)min,平均术后住院时间为(2.90±1.06)d,平均术后下床时间为(0.53±0.30)d,平均术中出血量为(6.52±2.15)mL。术后随访6~60个月,所有患者未见明显囊肿复发,且囊肿完全消失或明显缩小。结论符合适应证的肾盂旁囊肿患者采用经尿道输尿管软镜下钬激光内切开引流术安全、可靠,且手术时间短、出血量小、术后恢复快、复发率低,是肾盂旁囊肿可选的理想治疗方式之一。Objective To evaluate the safety and effectiveness of incision and drainage with Holmium laser under flexible ureteroscope in the treatment of parapelvic cysts.Methods The clinical data of 21 patients with parapelvic cysts in Beijing Friendship Hospital,Capital Medical University from January 2018 to December 2022 were retrospectively analyzed,including 10 males and 11 females.The average age was(62.86±5.38)years,and median age was 63.0 years,aged from 36-72 years.The maximum diameter of the cyst was 33-71 mm,with an average of(53.46±9.68)mm.There were 15 cases with homolateral hydronephrosis and 6 cases with homolateral renal calculus.The patients included in the study were treated with incision and drainage with Holmium laser under flexible ureteroscope.The double J ureteral catheter was removed and the urinary system ultrasound was repeated one month after surgery.CT on bilateral kidney was repeated every 6 months until 12 months after surgery.Subsequently,ultrasound on bilateral kidney was reviewed regularly every year.Prognostic indexes sunch as operation time,postoperative hospital stay,postoperative time of getting out of bed,intraoperative blood loss,recurrence and shrinkage of renal cysts were recorded.Results Of the 21 patients who underwent incision and drainage with Holmium laser under flexible ureteroscope,9 cases(42.9%)underwent the one-stage operation and 12 cases(57.1%)underwent the two-stage operation.The mean operative time was(41.57±10.86)min,the mean postoperative hospitalization time was(2.90±1.06)d,the mean time of getting out of bed was(0.53±0.30)d,and the mean intraoperative blood loss was(6.52±2.15)mL.No significant recurrence of cysts was observed in all patients after 6-60 months of follow-up,and the cysts disappeared completely or shrank significantly.Conclusion Incision and drainage with Holmium laser under flexible ureteroscope is safe and reliable in patients with parapelvic cysts,with short operation time,minor blood loss,rapid postoperative recovery and low recurrence rate,w

关 键 词：输尿管镜 激光疗法 治疗结果 肾盂旁囊肿 切开引流术 

分 类 号：R699[医药卫生—泌尿科学]