肾囊性疾病和肾盏憩室的腔镜下切开内引流术

目的：探讨经皮。肾镜及逆行软性输尿管肾镜下切开内引流术治疗。肾囊性疾病和肾盏憩室的安全性和可行性。方法：回顾性分析2010年1月～2013年2月对23例患者采用经皮肾镜及逆行软性输尿管肾镜下肾囊肿或肾盏憩室内切开引流术的临床资料。其中单纯肾囊肿5例，肾盂旁囊肿11例，肾盏憩室6例，多囊肾1例。囊肿、憩室直径平均4．7cm。手术方法采用全麻，顺行经皮。肾镜或逆行软性输尿管。肾镜下观察囊肿憩室的解剖位置及形态。直视下用钬激光将憩室口内切开扩大或凸起的菲薄囊壁切开一定范围开窗引流，使之与集合系相通。术后留置双J管引流。结果：23例患者均手术成功。手术时间36～75rain，平均48．9min。术后无大出血、严重感染、尿漏等并发症。术后随访3～24个月，11例囊肿消失，5例囊肿明显缩小，6例肾盏憩室消失，1例多囊肾囊肿（直径〉2cm者）数量明显减少。结论：经皮肾镜及逆行软性输尿管肾镜下内切开引流术治疗肾囊性疾病和肾盏憩室具有安全、有效，恢复快的特点，远期疗效有待进一步观察随访。

Incision and internal drainage treatment of renal cyst and calyceal diverticulum by endoscope

To evaluate the efficacy and safety of transurethal ureteroscopy or percutaneous nephros- copy techniques in treating renal cyst and calyceal diverticulum by incision and internal drainage. Method：Twentythree patients with renal cystic diseases, of which, 5 cases of simple renal cysts, 11 cases of peripelvic renal cyst, 6 cases of renal ealyceal diverticulum, 1 cases of polycystic kidney, and the average diameter of cysts was 4.7 cm, had undergone incision and internal drainage by nephroscope or flexible ureterscope from January, 2010 to October, 2012. With general anesthesia, the anatomy and morphology of renal cyst or calyceal diverticulum were ob served under antegrade percutaneous nephroscope or retrograde flexible uretero renoscope. The renal calyceal di verticulum necks or the renal cyst convex thin walls were expanded or fenestrated by holmium laser, and make them communicated with the pelvis. A double J stent was placed at the end of procedure. Result：All operations were successful without severe complications. The mean operating time was 48.9 rain （36 75 min）. After the follow-up of 3-24 month, 11 cases of renal cysts disappeared, 5 cases of renal cysts was significantly reduced, 6 cases of renal calyceal diverticulum disappeared, the number of cyst （diameter 〉2 cm ） significantly reduced in 1 case of polycystic kidney. Conclusion：Incision and internal drainage of renal cyst and calyceal diverticulum with transurethal ureteroscopy and percutaneous nephroscopy techniques by endoscope is effective, minimal invasive and safe, and the long-term effect needs further follow-up observation.