经皮微通道同期治疗肾盂旁囊肿合并肾盂输尿管连接部狭窄的疗效观察

发布时间：2018-08-20 09:47

【摘要】：目的探讨经皮微通道途径同期治疗肾盂旁囊肿合并肾盂输尿管连接部狭窄(ureteropelvic junction obstruction,UPJO)的安全性和可行性。方法回顾性分析2011年1月~2015年10月36例单侧单发肾盂旁囊肿合并UPJO资料。囊肿直径3~6.5 cm,平均4.5 cm,狭窄段长0.5~1.8 cm,平均1.2 cm。伴同侧肾结石28例,结石直径0.5~1.2 cm,平均0.8cm。重度肾盂积水15例,中度积水18例,轻度积水3例。硬膜外麻醉,俯卧位,伴有肾结石者先行经皮微通道钬激光碎石术,经皮微通道行肾盂旁囊肿钬激光切开内引流术,直视下用200μm钬激光将向集合系统凸起明显部囊壁开窗引流,使囊腔与集合系统相通。UPJO行顺行球囊扩张术。术后留置输尿管支架管引流3~6个月。结果 36例手术顺利完成。囊肿开窗引流时间15~30 min,平均20 min,狭窄球囊扩张时间4~10 min,平均6 min,无严重并发症发生。术后随访9~27个月,平均24个月。输尿管镜复查,34例扩张后输尿管镜体顺利通过,2例输尿管纤维炎性狭窄镜体不能通过。结论经皮微通道途径可同期治疗肾盂旁囊肿合并UPJO,近期疗效确切,安全有效。
[Abstract]:Objective to evaluate the safety and feasibility of percutaneous microchannel approach in the simultaneous treatment of parapelvic cysts with ureteropelvic junction stenosis (ureteropelvic junction obstruction UPJO). Methods from January 2011 to October 2015, 36 cases of unilateral parafelvic cysts with UPJO were retrospectively analyzed. The diameter of cyst was 36.5 cm (mean 4.5 cm) and the length of stenosis was 0.5 cm (1.8 cm) with an average of 1.2 cm. 28 cases were accompanied by ipsilateral renal calculi, the diameter of stones was 0.5 ~ 1.2 cm (mean 0.8 cm). 15 cases had severe hydronephrosis, 18 cases had moderate hydronephrosis and 3 cases had mild hydronephrosis. Epidural anesthesia, prone position and renal calculi were performed first by percutaneous microchannel holmium: YAG laser lithotripsy. Percutaneous microchannels were performed with holmium: YAG laser incision and internal drainage of parapelvic cysts. Under direct vision, 200 渭 m holmium laser was used to open windows to the prominent part of the collecting system. Make the cavity communicate with the collection system. UPJO perform the anterograde balloon dilatation. The drainage of ureteral stent was 3 ~ 6 months after operation. Results 36 cases were successfully completed. The time of fenestration and drainage of cyst was 1530 min (mean 20 min), and the time of balloon dilation was 4 ~ 10 min (mean 6 min). No serious complications occurred. Postoperative follow-up ranged from 9 to 27 months (mean 24 months). Ureteroscopy was performed in 34 cases with dilated ureteroscope and 2 cases with ureteral fibroinflammatory stenosis. Conclusion Percutaneous microchannel approach is safe and effective in the treatment of parapelvic cysts with UPJO.
【作者单位】：河北大学附属医院泌尿外科;河北大学;
【分类号】：R699

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