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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:

17

期数:

2017年09期

页码:

808-810

栏目:

临床论著

出版日期:

2017-09-20

文章信息/Info

Title:

Observation of the Therapeutic Effects of Percutaneous Microchannel Approach Concurrent Treatment of Parapelvic Cyst and Ureteropelvic Junction Obstruction

作者:

赵春利 周可义① 杨文增 张彦桥 崔振宇*

河北大学附属医院泌尿外科，保定071000

Author(s):

Zhao Chunli*;  Zhou Keyi;  Yang Wenzeng*;  et al.

*Department of Urology, Affiliated Hospital of Hebei University, Baoding 071000, China

关键词:

经皮微通道途径; 肾盂旁囊肿; 肾盂输尿管连接部狭窄; 球囊扩张

Keywords:

Percutaneous microchannel approach; Parapelvic cyst; Ureteropelvic junction obstruction; Balloon dilatation

文献标志码:

A

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0.8 cm。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200 μm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:

ObjectiveTo discuss the security and feasibility of percutaneous microchannel approach concurrent treatment of parapelvic cyst and ureteropelvic junction obstruction (UPJO).MethodsThe paper performed a retrospective analysis on data of 36 cases of unilateral and single parapelvic cyst combined with UPJO from January 2011 to October 2015. The average cyst diameter was 4.5 cm (range, 3-6.5 cm). And the average length of stenosis segment was 1.2 cm (range, 0.5-1.8 cm). There were 28 cases of ipsilateral kidney stones, with an average calculus diameter of 0.8 cm (range, 0.5-1.2 cm). There were 15 cases of severe hydronephrosis, 18 cases of moderate hydronephrosis, and 3 cases of mild hydronephrosis. The operation was performed under epidural anesthesia and the patients were placed at prone position. For those combining with kidney stones, percutaneous microchannel holmium laser lithotripsy was given firstly. And then percutaneous microchannel parapelvic cyst holmium laser incision drainage was conducted. Under direct vision, fenestration drainage on the capsule wall of collection system raised part was performed by using 200 μm holmium laser to make the cyst cavity connecting with collecting system. For UPJO, an anterograde balloon dilatation was given. A ureteral stent was placed for 3-6 months for drainage.ResultsThe surgery was accomplished smoothly in all the 36 cases. The average duration of cyst fenestration drainage was 20 min (range, 15-30 min). The stenosis balloon dilatation time was 6 min (range, 4-10 min). No serious complications occurred. We performed postoperative follow-ups for 9-27 months (average, 24 months). Ureteroscopic examinations showed 34 cases of smooth passing through of ureteroscopy and 2 cases of ureteral fiber inflammatory stenosis failed to pass through.ConclusionThe short-term curative effect of percutaneous microchannel approach concurrent treatment of parapelvic cyst and UPJO is definite, safe and effective.

备注/Memo

备注/Memo:

*通讯作者，E-mail：cuizhenyu615@163.com①（河北大学，保定071000）

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更新日期/Last Update: 2017-11-27