输尿管软镜下钬激光治疗肾盂旁囊肿合并肾结石的应用

摘要

Objective To investigate the safety and feasibility of flexible ureteroscope/holmium laser therapy of parapelvic cyst complicating with renal calculi.Methods The clinical data of 8 patients diagnosed as parapelvic cyst with renal calculi and hospitalized in our hospital from Nov.2012 to Nov.2014 were retrospectively analyzed.They were 5 males and 3 females,aged 54 78 years,with an average of 63 years old.The largest kidney calculis were at the size of (1.2 cm× 1.1 cm) to (1.5cm×2.0 cm),and the size of parapelvic cysts ranged between (3.2 cm×3.6 cm) and (5.1 cm×4.2cm).Waist pain was found in 6 patients,hematuria in 3 patients,hydronephrosis in 1 patient,circumscribed hydrocalycosis in 2 patients,hypertension in 3 patients,and infection of urinary tract in 3 patients.Incision and internal drainage of parapelvic cyst and lithotripsy for renal calculi were conducted by flexible ureteroscope/holmium laser under general anesthesia.Results All of the 8 patients had successful operations without any complications such as massive haemorrhage,pararenal hematoma,extravasation of urine,infectious shock and kidney atrophy during or after the operation.The operation time ranged between 52 to 120 minutes,with the average of 76 minutes.All patients showed no residual renal calculus during a follow-up period of 3 to 12 months.Renal cysts were disappeared in 6 patients,and the size of renal cysts was significantly decreased in the other 2 cases.No parapelvic cyst and renal calculus recurred during the follow-up.Conclusions Flexible transurethral ureteroscope/Holmium laser therapy is a good method with the advantages of minimal trauma,quick recovery,simple operation,economic,safety and effectiveness in treating parapelvic cyst complicating with renal calculus.%目的 探讨输尿管软镜下钬激光治疗肾盂旁囊肿合并肾结石的手术方法、安全性、可行性. 方法 回顾性分析我院2012年11月至2014年11月共收治8例肾盂旁囊肿合并肾结石患者的临床资料,其中男5例,女3例,年龄54～78岁,平均63岁.最大单颗肾结石大小1.2 cm×1.1cm ～1.5 cm×2.0 cm,囊肿大小3.2cm×3.6 cm～5.1 cm×4.2cm,腰部酸胀不适6例,血尿3例,肾盂积水1例,局限性肾盏积水2例,合并高血压3例,泌尿系感染3例.在全麻下行经尿道输尿管软镜钬激光下肾盂旁囊肿内切开引流+肾结石碎石取石术. 结果 8例手术均成功,处理结石及囊肿时间共为52～120 min,平均76 min.术中、术后无大出血、肾周血肿、尿外渗、感染性休克、患肾萎缩等并发症发生,术后随访3～12个月,全部病例无肾结石残留,其中6例囊肿消失,2例囊肿明显缩小,随访期内无复发. 结论 经尿道输尿管软镜下钬激光治疗肾盂旁囊肿合并肾结石具有创伤小、恢复快、术式简单、经济、安全有效等优点.