摘要
目的：探讨微创通道经皮肾镜铱激光内切开引流治疗肾深部囊肿的临床疗效。方法：2009年2月-2012年12月，应用微创通道经皮肾镜钬激光内切开引流治疗肾深部囊肿30例，其中男19例，女11例，年龄36-58岁，平均47岁。囊肿直径5．O～7．0cm，平均6．0cm，均为壁厚且与肾集合系统接近。12例在B超引导、监视下由囊肿下毗邻的肾盏穿刺进入肾盂，置入输尿管镜，钬激光于囊肿中心烧灼开放肾盂及囊肿。18例经皮穿刺进入囊肿，置入输尿管镜，钬激光烧灼开放囊肿至肾盂，术后常规留置肾造瘘管及内支架管引流。结果：30例患者手术均获成功，手术时间50～90min，平均70min，术中失血20～100ml，无中转开放手术。术后2d拔出导尿管，5～7d拔出肾造瘘管，经皮肾瘘口24小时自行愈合，无尿瘘情况发生。住院时间7～9d，平均8d。术后2个月拔出双J管。30例均随访3～24个月，29例未见囊肿复发，1例术后1年复发但直径〈2．0cm。结论：微创通道经皮肾镜钬激光内切开引流治疗肾深部囊肿是一种损伤更小、安全、有效的微创新术式，与其他术式相比较，具有明显优势。
Abstract Objective： To investigate the clinical effects of minimally invasive percutaneous nephroscopy by hol- mium laser for endo-incision and drainage of deep kidney cysts. Method： From Feb. 2009 to Dec. 2012, 30 cases were treated with minimally invasive percutaneous nephroscopy by holmium laser for endo-ineision and drainage of deep kidney cysts, including 19 males and 11 females. The average age of the patients was 47 （range, 36-58） years old. The average diameter of cysts was 6.0 （range, 5.0-7.0） cm. All cysts with thick walls were closed to the renal collecting system. Twelve cases guided and monitored by B ultrasound were inserted via kidney calices, which were adjoined the cysts, to the renal pelvis. Then, we inserted ureteroscope, cauterizing and opening pelvis and cysts by holmium laser. Percutaneous ureteroscopes were used in 18 cases. We then cauterized and opened cysts to pelvis by holmium laser. Routine postoperative indwelling of nephrostomy tubes were used in all cases . Result： All surgeries were successful without conversion to open surgery. The average operation time was 70 （50- 90） min. The intraoperative blood loss was 20-100 ml. Urethral catheter, nephrostomy tube and double-J tube were pulled out two days, five to seven days and two months after the operation respectively. The nephrostomy incision heals itself 24 hours later without urinary fistula. The average hospital stay was 8 （range, 7-9） d. After 3-24 months of follow-up period, 29 cases have no recurrence except one patient had recurrence with the cyst di- ameter less than 2.0 cm. Conclusion： Minimally invasive percutaneous nephroscopy by holmium laser for endo-in- cision and drainage of deep kidney cysts is a new procedure with less invasion, safe and efficiency compared with other sugeries.
出处
《临床泌尿外科杂志》
2014年第2期132-134,共3页
Journal of Clinical Urology
关键词
微创经皮肾镜术
钬激光
内切开引流
肾囊肿
minimally invasive percutaneous nephroscopy
holmium laser~ endo-incision and drainage
renalcyst
