超声引导输尿管软镜钬激光内切开引流术治疗特殊肾囊性疾病48例疗效分析

Efficacy of ultrasound-guided transurethral flexible ureteroscopic holmium laser incision and internal drainage in 48 patients with special renal cystic diseases

摘要

目的 探讨超声引导下输尿管软镜钬激光内切开引流术治疗特殊肾囊性疾病的疗效及手术技巧，为此类疾病的诊治提供参考。方法 回顾性分析2019年1月-2023年5月兰州大学第一医院泌尿外科收治的48例特殊肾囊性疾病患者的临床资料。所有患者均经泌尿系计算机断层扫描（CT）平扫+增强及三维尿路重建确诊，均接受斜仰卧截石位下超声引导下输尿管软镜钬激光内切开引流术治疗。对患者的一般资料、诊治资料及并发症发生情况进行总结。结果 48例患者中男性27例，女性21例，平均年龄（48.0±7.5）岁。其中肾盂旁囊肿22例、内生型单纯性肾囊肿6例，囊肿平均直径（5.0±1.0）cm；肾盏憩室合并结石20例，憩室平均直径（2.5±1.3）cm、结石平均直径（1.5±1.0）cm，均为上盏或中盏结石。术中7例超声引导下输尿管软镜定位困难，改用经皮肾穿刺针辅助定位；2例术中发现输尿管狭窄，放置双J管扩张4周后再次手术。平均手术时间（42.0±14.5）min、住院时间（2.0±0.5）d、随访时间（12.0±8.5）个月。27例（100%）术后腰痛症状改善，23例（82.1%，23/28）囊肿完全消失、4例（14.3%，4/28）囊肿缩小≥50%、1例（3.6%，1/28）囊肿缩小＜50%。20例（100%）患者的肾盏憩室伴结石术后均萎缩消失。2例出现肉眼血尿或尿路刺激征，所有患者中未见Clavien-Dindo Ⅲ～Ⅳ级并发症发生。结论 超声引导下输尿管软镜钬激光内切开引流术治疗特殊肾囊性疾病安全有效。术中超声引导输尿管软镜定位困难时，可选择经皮肾穿刺针辅助定位。

Abstract

Objective To explore the efficacy and surgical techniques of ultrasound-assisted transurethral flexible ureteroscopic holmium laser incision and internal drainage in the treatment of special renal cystic diseases, so as to provide reference for the diagnosis and treatment of such diseases. Methods The clinical data of 48 patients with special renal cystic diseases treated during Jan. 2019 and May 2023 were retrospectively analyzed. The diagnosis was made by computed tomography urography (CTU) and three dimensional urinary tract reconstruction before operation. All patients received the abovementioned surgery in semisupine lithotomy position. The general information, clinical data, and incidence of complications were analyzed. Results There were 27 males and 21 females, with an average age of (48.0±7.5) years, including 22 cases of parapelvic cysts, 6 cases of endogenic simple renal cysts with an average diameter of (5.0±1.0) cm, and 20 cases of renal calyceal diverticulum with stones, with an average diameter of (2.5±1.3) cm for the diverticulum and an average diameter of (1.5±1.0) cm for the stones, which were located in the upper or middle calyces. In 7 cases, ureteroscopic localization was difficult, and the surgery was completed with percutaneous renal puncture needle assisted localization. Ureteral stenosis was detected in 2 cases during surgery, and surgery was performed 4 weeks after double J tubes were placed. The remaining operations were successfully completed. The average operation time was (42.0±14.5) minutes, and average hospital stay was (2.0±0.5) days. During the follow-up of (12.0±8.5) months, lumbar pain improved in 27 cases (100%), renal cysts disappeared in 23 cases (82.1%, 23/28), cysts significantly reduced by ≥50% in 4 cases (14.3%, 4/28), slightly reduced by <50% in 1 case (3.6%, 1/28), and the renal calyx diverticulum disappeared in 20 cases (100%). Gross hematuria and lower back pain occurred in 2 cases, and no other complications developed. Conclusion Ultrasound-guided transurethral flexible ureteroscopic holmium laser incision and internal drainage is a safe and effective treatment for special benign renal cystic diseases. When ultrasound-guided flexible ureteroscope localization is difficult to perform, percutaneous renal puncture needle may be applied.

关键词

超声检查 / 输尿管软镜 / 经皮肾穿刺 / 钬激光 / 肾囊肿 / 肾盏憩室结石

Key words

ultrasonography / flexible ureteroscope / percutaneous renal puncture / holmium laser / renal cyst / calyceal diverticulum with stones

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