软性输尿管镜下钬激光同期治疗肾结石合并肾囊肿的疗效观察.docVIP

精品论文 参考文献 软性输尿管镜下钬激光同期治疗肾结石合并肾囊肿的疗效观察 李泽平 江汛 廖春望 李新 陈思亮 　　湖南省岳阳市二人民医院泌尿外科 湖南岳阳 414000 　　【摘 要】目的 报告软性输尿管镜下钬激光同期治疗肾结石合并肾囊肿的初步经验，并评价其安全性和可行性。方法 回顾性分析2012年6月至2014年12月我院收治的7例经Ｂ超、ＣＴ和ＩＶＵ检查确诊的肾结石并肾囊肿患者行软性输尿管镜下钬激光治疗肾结石并肾囊肿内切开引流术。男3例，女4例。年龄41岁-65岁，平均年龄52.7岁。单发肾盂结石4例，单发肾上盏结石2例，多发结石1例；结石平均1.7cm（1.3-2.5cm）。合并囊肿均为单纯性囊肿，大小4.0-8.2cm，平均5.5cm。术前1周于膀胱镜下留置双J管或输尿管导管。气管插管静脉复合麻醉下术中沿软镜输送鞘逆行进镜，寻找结石和囊肿（无法寻及者，辅助以Ｂ超定位）。将钬激光功率调至le;20W（0.6-1.0J/10-20Hz）先碎石后于囊肿壁最薄处切开，扩大切口至2.0cm。留置Ｆ6或F7输尿管双Ｊ管，将其近端留置于囊肿内，保留1-3月后拔除。结果 本组7例手术均顺利放置软镜鞘，一次性成功率100%。4例进镜至肾盂后寻及结石和囊肿，3例找到结石未发现囊肿，通过仔细阅读CT片并在超声引导下定位。中位手术时间89（42～175）min，无大出血、周围脏器损伤、感染性休克等并发症发生。术后复查Ｂ超或ＣＴ示残留肾结石均小于4mm且肾囊肿直径均缩小1/2以上。结论 软性输尿管镜下钬激光治疗肾结石并内生性肾囊肿内切开引流术具有安全、微创、简便可行、并发症少、恢复快、近期疗效确切、美容效果极佳等优点，适合肾结石小于2cm并内生性肾囊肿的治疗。 　　【关键词】软性输尿管镜；钬激光；肾结石；肾囊肿 　　[Abstract]Objective To describe the initial clinical experience of flexible ureteroscopy with holmium laser lithotripsy and drainage treatment of renal calculi accompanying to intrarenal cyst，and evaluate its feasibility and safety.Methods We retrospectiviely reviewed the records of 7 patients，three male patients and four female patients with renal stones associated with intrarenal cyst underwent flexible ureteroscopy with holmium laser lithotripsy and drainage treatment from June 2012 to December 2014.The median age was 52.7（ranged from 41 to 65 years old）years old.In this group，four cases had solitary stones in renal pelvis，two cases had solitary stones at upper calyx and multiple stones were found in one case.Mean size of stone was 1.7cm（ranged from 1.3 to 2.5 cm）.The intrarenal cysts of all cases were confirmed by B ultrasound，CT scan and IVU.The median diameter of renal cyst was 5.5 cm（range from 4.0 to 8.2cm）.The double J stent or ureteral catheter was placed into the ureter by cystoscope two weeks before the operation.Under the general anesthesia，the ureteral access sheath was placed firstly during operation.Then flexible ureteroscopy was inserted into the renal pelvis through ureteral access sheath.H