超声定位输尿管软镜治疗肾囊性疾病的临床分析

目的探讨超声辅助定位输尿管软镜治疗肾囊性疾病的安全性和有效性。方法回顾性分析2015年3月~2019年6月27例输尿管软镜治疗肾囊性疾病的资料。单侧肾囊肿5例,双侧肾囊肿3例,肾盂旁囊肿伴同侧肾结石14例,单发肾盂旁囊肿4例,双侧肾盂旁囊肿1例。囊肿直径3.5~7.8 cm,平均5.1 cm。结石直径0.5~1.2 cm,平均0.6 cm。超声监控,输尿管软镜下应用钬激光对肾集合系统的囊壁行开窗引流,使集合系统与囊壁相通并留置双J管引流。合并结石者先处理结石后处理囊肿。结果27例手术均成功。手术时间11~53 min,平均35 min。无严重并发症发生。术后1~2个月取出双J管,继续随访2~24个月,平均9个月。影像学检查显示16例囊肿消失,其余11例囊肿由术前3.8~6.7 cm缩小至1.2~3.0 cm,未见囊肿复发。14例合并同侧肾结石者,结石0.2~0.4 cm。结论超声辅助定位输尿管软镜钬激光切开内引流术治疗肾囊性疾病安全有效。

Clinical Analysis on the Treatment of Renal Cystic Diseases by Ultrasound Guided Flexible Ureteroscopy

Objective To investigate the safety and effectiveness of flexible ureteroscopy under the guidance of color Doppler ultrasound in the treatment of renal cystic diseases.Methods From March 2015 to June 2019,clinical data of 27 patients with renal cystic disease treated with flexible ureteroscopy were retrospectively analyzed.There were 5 cases of unilateral renal cysts,3 cases of bilateral renal cysts,14 cases of parapelvic cysts with ipsilateral kidney stones,4 cases of single parapelvic cysts,and 1 case of bilateral parapelvic cysts.The diameter of the cysts was ranged from 3.5-7.8 cm(mean,5.1 cm).The stones were measured as 0.5-1.2 cm in diameter(mean,0.6 cm).Under the guidance of color Doppler ultrasound monitoring,the sac wall of the kidney collection system was fenestrated for drainage by the application of flexible ureteroscopy combined with holmium laser,so that the collection system could be communicated with the sac wall and indwelling the double J tube drainage.Those who combined with calculi were treated of the calculi first then the cysts.Results The operations were successfully accomplished in all the 27 cases.The operation time was 11-53 minutes,with an average of 35 minutes.There was no serious complications occurred.The double J tube was removed 1-2 months after surgery,and the follow-up period was conducted for 2-24 months after extubation,with an average of 9 months.The imaging examinations showed that 16 cases of cysts disappeared,and the remaining 11 cases with cysts sized as 3.8-6.7 cm before surgery had reduced to 1.2-3.0 cm,without any recurrence of cysts.The stones were reduced to 0.2-0.4 cm in 14 patients with ipsilateral kidney stones.Conclusion The flexible ureteroscopy guided by color Doppler ultrasound combined with holmium laser incision and drainage is safe and effective for the treatment of renal cystic diseases.