输尿管软镜下钬激光内切开引流术治疗肾盂旁囊肿11例报告
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摘要
目的探讨经尿道输尿管软镜钬激光内切开引流术在治疗肾盂旁囊肿疾病中的适用性与可行性。方法回顾性分析2016年1月-2018年1月该院收治的11例肾盂旁囊肿患者的病史资料,男5例,女6例,年龄45～73岁,平均58.8岁,囊肿位于左侧3例,右侧5例,双侧3例,直径3.9～7.8 cm,平均5.2 cm。7例并发单侧或双侧肾结石,2例合并肾功能不全,另分别各1例合并右肾积水、左输尿管结石、膀胱结石或多囊肾。11例均在全麻下行经尿道输尿管软镜下肾盂旁囊肿钬激光内切开引流术,部分合并尿石症者均一并行钬激光碎石取石术。术中先留置斑马导丝,沿斑马导丝插入Cook输尿管软镜鞘管至肾盂管连接处,沿输尿管软镜鞘插入Olympus电子输尿管软镜,顺利通过肾盂管连接处进入肾盂,接着用200μm钬激光光纤于囊肿挤压明显且肾盂壁薄处汽化切开,保证局部引流通畅,最后经输尿管软镜置入斑马导丝至切开囊内,拔除鞘管,并留置双J管引流。结果 11例患者均顺利完成手术,术中及术后无重大并发症。术后随访3～24个月,4例有腰痛症状者症状逐渐好转,2例血尿患者最终血尿消失;影像学检查结果示8例囊肿消失,3例囊肿相比术前CT直径明显减小;2例伴肾功能不全患者血肌酐水平稳中有降,1例合并肾积水患者积水明显减少。结论经尿道输尿管软镜钬激光切开内引流术在治疗肾盂旁囊肿微创、有效和安全可靠。
Objective To investigate the applicability and feasibility of transurethral flexible ureteroscopic holmium laser internal incision and drainage in the treatment of parapelvic cysts. Methods A retrospective analysis was performed on the medical records of 11 patients with parapelvic cysts from January 2016 to January 2018,including 5 males and 6 females. The mean age was 58.8 years(range from 45 ～ 73). The cysts were located in the left side in 3 cases, the right side in 5 cases, and bilateral in 3 cases. The diameter ranges from 3.9 ～ 7.8 cm and the average was 5.2 cm. There were 7 cases with unilateral or bilateral renal calculi, 2 cases with renal insufficiency, and1 case with right hydronephrosis, left ureteral calculi, bladder calculi and polycystic kidney respectively. 11 cases underwent transurethral flexible ureteroscope holmium laser internal incision and drainage after general anesthesia,and holmium laser lithotripsy was performed in some patients with ureterolithiasis. Firstly, the zebra guide wire was retained in the operation and the cook ureter soft mirror sheath was inserted along the zebra guide wire to the junction of the renal pelvis. The Olympus electronic ureteroscope was inserted into the soft mirror ureter sheath to enter the renal pelvis. Secondly, the 200 um holmium laser fiber was used to vaporize the thin part of the renal pelvis wall where the cyst was extruded obviously to ensure the patency of local drainage. Last, the zebra guide wire was placed into the incised capsule through the ureteroscope, the sheath tube was removed, and the double J tube was retained for drainage. Results All the 11 operations were successfully performed without significant complications during and after operation. After 3 ～ 24 months of follow-up, 4 cases with lumbago symptoms were relieved and 2 cases of hematuria disappeared; 8 cases of cysts disappeared, 3 cases of cysts decreased significantly compared with the preoperative period, and 2 cases with renal insufficiency, the serum creatinine level decreased steadily, and 1 case with hydronephrosis was obviously relieved. Conclusion Transurethral flexible ureteroscope holmium laser internal incision and drainage is effective, safe and reliable in the treatment of parapelvic cyst.
Objective To investigate the applicability and feasibility of transurethral flexible ureteroscopic holmium laser internal incision and drainage in the treatment of parapelvic cysts. Methods A retrospective analysis was performed on the medical records of 11 patients with parapelvic cysts from January 2016 to January 2018,including 5 males and 6 females. The mean age was 58.8 years(range from 45 ～ 73). The cysts were located in the left side in 3 cases, the right side in 5 cases, and bilateral in 3 cases. The diameter ranges from 3.9 ～ 7.8 cm and the average was 5.2 cm. There were 7 cases with unilateral or bilateral renal calculi, 2 cases with renal insufficiency, and1 case with right hydronephrosis, left ureteral calculi, bladder calculi and polycystic kidney respectively. 11 cases underwent transurethral flexible ureteroscope holmium laser internal incision and drainage after general anesthesia,and holmium laser lithotripsy was performed in some patients with ureterolithiasis. Firstly, the zebra guide wire was retained in the operation and the cook ureter soft mirror sheath was inserted along the zebra guide wire to the junction of the renal pelvis. The Olympus electronic ureteroscope was inserted into the soft mirror ureter sheath to enter the renal pelvis. Secondly, the 200 um holmium laser fiber was used to vaporize the thin part of the renal pelvis wall where the cyst was extruded obviously to ensure the patency of local drainage. Last, the zebra guide wire was placed into the incised capsule through the ureteroscope, the sheath tube was removed, and the double J tube was retained for drainage. Results All the 11 operations were successfully performed without significant complications during and after operation. After 3 ～ 24 months of follow-up, 4 cases with lumbago symptoms were relieved and 2 cases of hematuria disappeared; 8 cases of cysts disappeared, 3 cases of cysts decreased significantly compared with the preoperative period, and 2 cases with renal insufficiency, the serum creatinine level decreased steadily, and 1 case with hydronephrosis was obviously relieved. Conclusion Transurethral flexible ureteroscope holmium laser internal incision and drainage is effective, safe and reliable in the treatment of parapelvic cyst.
引文
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[6]CICIONE A, AUTORINO R, LAGUNA M P, et al. Threedimensional technology facilitates surgical performance of novice laparoscopy surgeons:a quantitative assessment on a porcine kidney model[J]. Urology, 2015, 85(6):1252-1256.
[7]李伟,邹岷,肖民辉,等.经输尿管软镜钬激光内切开引流治疗肾盂旁囊肿八例报告[J].中华泌尿外科杂志, 2013, 34(6):421.[7]LI W, ZOU M, XIAO M H, et al. Report of 8 cases of parapelvic cyst treated by holmium laser internal incision and drainage under flexible ureteroscope[J]. Chinese Journal of Urology, 2013, 34(6):421. Chinese
[8]杨嗣星,吴旭,廖文彪,等.输尿管软镜下钬激光内切开引流术治疗肾囊性疾病的安全性及疗效[J].中华泌尿外科杂志, 2016,37(1):17-20.[8]YANG S X, WU X, LIAO W B, et al. Safety and efficacy of flexibleureteroscopicholmiumincisionanddrainageforrenal cystic diseases[J]. Chinese Journal of Urology, 2016, 37(1):17-20.Chinese
[9]MAO X W, XU G, WU H F, et al. Ureteroscopic management of asymptomaticandsymptomaticsimpleparapelvicrenalcysts[J].BMC Urology, 2015, 15(1):48.
[10]JANCZAK D, BOLANOWSKA B, JANKOWSKI P, et al. Ex vivopyelotomy,nephroscopyandholmiumlaserlithotripsyof astaghornstoneinadonorkidneypriortorenaltransplant[J].Wideochir Inne Tech Maloinwazyjne, 2015, 10(2):286-289.
[2]WEIN A J, KAVOUSSI L R, PARTIN A W, et al. Campbell-Walsh urology[M]. 11th ed. Philadelphia:Elsevier, 2016:2975-3042.
[3]ZHAO Q, HUANG S, LI Q, et al. Treatment of parapelvic cyst by internal drainage technology using ureteroscope and holmium laser[J]. West Indian Medical Journal, 2015, 64(3):1.
[4]高健刚,孙小庆,侯四川,等.肾盂旁囊肿的后腹腔镜手术选择(附39例报告)[J].临床泌尿外科杂志, 2012, 27(11):807-808.[4]GAO J G, SUN X Q, HOU S C, et al. Retroperitoneal laparoscopic parapelvic cyst unroofing for treatment of parapelvic cyst(report of 39 cases)[J]. Journal of Clinical Urology, 2012, 27(11):807-808. Chinese
[5]王天刚,孟庆军,高瞻,等.经腹腔腹腔镜治疗肾盂旁囊肿28例[J].中华腔镜外科杂志:电子版, 2012, 5(1):47-49.[5]WANG TG,MENGQJ,GAOZ,etal. Transperitoneal laparoscopicparapelviccystunroofingof28cases[J].Chinese Journal of Laparoscopic Surgery:Electronic Edition, 2012, 5(1):47-49. Chinese
[6]CICIONE A, AUTORINO R, LAGUNA M P, et al. Threedimensional technology facilitates surgical performance of novice laparoscopy surgeons:a quantitative assessment on a porcine kidney model[J]. Urology, 2015, 85(6):1252-1256.
[7]李伟,邹岷,肖民辉,等.经输尿管软镜钬激光内切开引流治疗肾盂旁囊肿八例报告[J].中华泌尿外科杂志, 2013, 34(6):421.[7]LI W, ZOU M, XIAO M H, et al. Report of 8 cases of parapelvic cyst treated by holmium laser internal incision and drainage under flexible ureteroscope[J]. Chinese Journal of Urology, 2013, 34(6):421. Chinese
[8]杨嗣星,吴旭,廖文彪,等.输尿管软镜下钬激光内切开引流术治疗肾囊性疾病的安全性及疗效[J].中华泌尿外科杂志, 2016,37(1):17-20.[8]YANG S X, WU X, LIAO W B, et al. Safety and efficacy of flexibleureteroscopicholmiumincisionanddrainageforrenal cystic diseases[J]. Chinese Journal of Urology, 2016, 37(1):17-20.Chinese
[9]MAO X W, XU G, WU H F, et al. Ureteroscopic management of asymptomaticandsymptomaticsimpleparapelvicrenalcysts[J].BMC Urology, 2015, 15(1):48.
[10]JANCZAK D, BOLANOWSKA B, JANKOWSKI P, et al. Ex vivopyelotomy,nephroscopyandholmiumlaserlithotripsyof astaghornstoneinadonorkidneypriortorenaltransplant[J].Wideochir Inne Tech Maloinwazyjne, 2015, 10(2):286-289.