【摘要】 目的:评价斜仰截石位输尿管软镜下钬激光切开内引流治疗肾囊性疾病的治疗方法与安全性。方法:回顾性分析2013年3月～2018年1月间收治的32例肾囊性疾病患者的临床资料。男19例,女13例,年龄23～71岁,平均45.7岁,其中单纯肾囊肿16例,肾盂旁囊肿13例,肾盏憩室3例。囊腔平均直径为5.4cm(4.5～11.0cm),2例肾盏憩室合并结石,1例合并钙乳,结石平均直径为1.1cm(0.8～1.4cm)。术前行静脉肾盂造影或CT尿路造影检查,常规留置输尿管支架两周,全麻后取斜仰截石位行输尿管软镜下钬激光切开内引流术,术中用钬激光将向肾脏集合系统膨出的菲薄囊壁或者憩室颈部切开,留置双J管持续内引流。结果:32例均顺利完成手术,平均手术时间为52.3min(30～85min)、平均住院时间为5.2d(4～7d),无术后延迟性大出血、尿源性脓毒血症、输尿管穿孔、肾功能损害等严重并发症,术后随访6～24月,25例囊腔消失,7例囊腔较术前明显缩小,其中3例肾盏憩室的囊腔均萎缩消失,症状缓解,结石钙乳均清除。结论:在依据影像学准确评估和制定合理治疗措施的前提下,斜仰截石位输尿管软镜下钬激光切开内引流治疗肾囊性疾病是安全有效的方法。更多还原

【Abstract】 Objective:To evaluate the approach and safety of flexible ureteroscopic holmium laser incision and internal drainge in semisupine lithotomy position for renal cystic disease.Methods:From March 2013 to January2018,clinical data of 32 patients with renal cystic disease were retrospectively reviewed,including 16 cases of simple renal cyst,13 cases of peripelvic renal cyst and 3 cases of caliceal diverticulum.Of all the patients,19 were males and 13 were females.The mean age was 45.7 years(ranging 23-71 years).The mean diameter of cysts was5.4 cm(ranging 4.5-11.0 cm)and the mean diameter of calculi was 1.1 cm(ranging 0.8-1.4 cm).In regards to 3 cases of caliceal diverticulum,2 cases were noticed with calculi and 1 case with renal milk of calcium.All patients received intravenous urography or CT urography preoperatively and underwent double-J stent placement 2 weeks before operations.These patients had undergone holmium laser incision and internal drainage in semisupine lithotomy position for renal cystic disease by using flexible ureteroscope under general anaesthesia,and had received double-J stent placement after operations.During the operation,holmium laser was retrogradely used to incise the convex thin walls of renal cystic cavity or caliceal diverticuluar necks.Results:Surgical operations were performed successfully on all patients,the mean operative time was 52.3 min(ranging 30-85 min)and the mean hospital stay was 5.2 days(ranging 4-7 days).There were no severe complications such as postoperative delayed hemorrhage,urosepsis,ureteral perforation,impairment of renal function.After the follow-up of 6-24 months,renal cystic cavity disappeared in 25 patients and was significantly reduced in 7 patients.Among them,there were 3 cases whose caliceal diverticulum disappeared and symptoms relieved after operations.The calculi and renal milk of calcium were removed.Conclusions:On the premise of accurate evaluation of imaging and creating reasonable treatment measures,flexible ureteroscopic holmium laser incision and internal drainge in semisupine lithotomy position is a safe and effective method for renal cystic disease.更多还原