超聲引導輸尿管軟鏡鈥激光內切開引流術治療特殊腎囊性疾病48例療效分析

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

ZHANG Xiaokang，ZHANG Wei，LIU Disheng，LI Wenhui，ZHAO Yanzong，HA Wuhua，ZHANG Bin

（Department of Urology，The First Hospital of Lanzhou University，Lanzhou 730030，China）

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 lt;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.

KEY WORDS：ultrasonography; flexible ureteroscope; percutaneous renal puncture; holmium laser; renal cyst; calyceal diverticulum with stones

摘要：目的 探討超聲引導下輸尿管軟鏡鈥激光內切開引流術治療特殊腎囊性疾病的療效及手術技巧，為此類疾病的診治提供參考。方法 回顧性分析2019年1月—2023年5月蘭州大學第一醫院泌尿外科收治的48例特殊腎囊性疾病患者的臨床資料。所有患者均經泌尿系計算機斷層掃描（CT）平掃+增強及三維尿路重建確診，均接受斜仰臥截石位下超聲引導下輸尿管軟鏡鈥激光內切開引流術治療。對患者的一般資料、診治資料及并發癥發生情況進行總結。結果 48例患者中男性27例，女性21例，平均年齡（48.0±7.5）歲。其中腎盂旁囊腫22例、內生型單純性腎囊腫6例，囊腫平均直徑（5.0±1.0）cm；腎盞憩室合并結石20例，憩室平均直徑（2.5±1.3）cm、結石平均直徑（1.5±1.0）cm，均為上盞或中盞結石。術中7例超聲引導下輸尿管軟鏡定位困難，改用經皮腎穿刺針輔助定位；2例術中發現輸尿管狹窄，放置雙J管擴張4周后再次手術。平均手術時間（42.0±14.5）min、住院時間（2.0±0.5）d、隨訪時間（12.0±8.5）個月。27例（100%）術后腰痛癥狀改善，23例（82.1%，23/28）囊腫完全消失、4例（14.3%，4/28）囊腫縮小≥50%、1例（3.6%，1/28）囊腫縮小＜50%。20例（100%）患者的腎盞憩室伴結石術后均萎縮消失。2例出現肉眼血尿或尿路刺激征，所有患者中未見Clavien-Dindo Ⅲ～Ⅳ級并發癥發生。結論 超聲引導下輸尿管軟鏡鈥激光內切開引流術治療特殊腎囊性疾病安全有效。術中超聲引導輸尿管軟鏡定位困難時，可選擇經皮腎穿刺針輔助定位。

關鍵詞：超聲檢查；輸尿管軟鏡；經皮腎穿刺；鈥激光；腎囊腫；腎盞憩室結石

中圖分類號：R692.4 文獻標志碼：ADOI：10.3969/j.issn.1009-8291.2025.02.008

腎囊性疾病包括單純性腎囊腫、腎盂旁囊腫、腎竇囊腫、髓質海綿腎、腎盞憩室以及多囊腎等，多數無癥狀無需治療^［1］。……