CAJ | 학술논문

目的：根据肾囊性病变特点建立差异性手术径路,使用输尿管镜钬激光内切开引流微创治疗肾囊肿；通过临床疗效评估研究,探讨输尿管镜在肾囊性病变治疗中的价值及临床应用前景.方法：2008年3月~2013年12月,对70例肾囊性病变患者采用输尿管镜钬激光内切开引流微创治疗.其中肾外周囊肿32例,15例囊肿位于肾盂前方靠腹侧,肾盂被囊肿推向背侧,选择经“皮→肾盂→囊肿”路径；17例囊肿位于肾盂后方靠背侧,肾盂被囊肿推向腹侧,选择经“皮→囊肿→肾盂”路径；肾盂旁囊肿38例,18例囊肿位于肾上极,选择经输尿管硬镜“尿道→肾盂→囊肿”路径；20例囊肿位于肾中、下极,选择经输尿管软镜“尿道→肾盂→囊肿”路径.所有病例囊肿直径4．5~7．0 c m,平均5．75 c m.49例患侧有腰背胀痛症状,21例为体检发现.术前均行B 超、I VU、CT 或 MRI 检查明确诊断为肾囊肿,术后留置双J 管.结果：70例患者手术均获成功,手术时间30~90 min ,平均60 min ,术中失血5~100 ml,平均52．5 ml.无中转开放手术及术中大血管损伤、误伤.术后2~3 d 拔出导尿管,住院时间5~9 d,平均7 d.经皮肾路径患者均无尿漏及尿外渗发生,术后2个月拔出双J 管.所有病例均获得随访3~24个月,经B 超或CT 检查68例未见囊肿复发.2例术后1年复发但直径均小于2．0 c m,输尿管镜检查证实囊肿内切开引流口再次闭合.结论：根据肾囊性病变的特点,制定差异性、个性化的手术路径,采取经输尿管镜钬激光内切开引流治疗是一种安全、有效、损伤小、复发率低的微创新术式,是输尿管镜在临床应用的拓展.与其他肾囊性病变的治疗方式对比,优势明显,具有良好的临床应用前景及推广使用价值.
목적：근거신낭성병변특점건립차이성수술경로,사용수뇨관경화격광내절개인류미창치료신낭종；통과림상료효평고연구,탐토수뇨관경재신낭성병변치료중적개치급림상응용전경.방법：2008년3월~2013년12월,대70례신낭성병변환자채용수뇨관경화격광내절개인류미창치료.기중신외주낭종32례,15례낭종위우신우전방고복측,신우피낭종추향배측,선택경“피→신우→낭종”로경；17례낭종위우신우후방고배측,신우피낭종추향복측,선택경“피→낭종→신우”로경；신우방낭종38례,18례낭종위우신상겁,선택경수뇨관경경“뇨도→신우→낭종”로경；20례낭종위우신중、하겁,선택경수뇨관연경“뇨도→신우→낭종”로경.소유병례낭종직경4．5~7．0 c m,평균5．75 c m.49례환측유요배창통증상,21례위체검발현.술전균행B 초、I VU、CT 혹 MRI 검사명학진단위신낭종,술후류치쌍J 관.결과：70례환자수술균획성공,수술시간30~90 min ,평균60 min ,술중실혈5~100 ml,평균52．5 ml.무중전개방수술급술중대혈관손상、오상.술후2~3 d 발출도뇨관,주원시간5~9 d,평균7 d.경피신로경환자균무뇨루급뇨외삼발생,술후2개월발출쌍J 관.소유병례균획득수방3~24개월,경B 초혹CT 검사68례미견낭종복발.2례술후1년복발단직경균소우2．0 c m,수뇨관경검사증실낭종내절개인류구재차폐합.결론：근거신낭성병변적특점,제정차이성、개성화적수술로경,채취경수뇨관경화격광내절개인류치료시일충안전、유효、손상소、복발솔저적미창신술식,시수뇨관경재림상응용적탁전.여기타신낭성병변적치료방식대비,우세명현,구유량호적림상응용전경급추엄사용개치.
Objective:To establish the individualized surgical approaches for hol miumlaser and incision drainage with ureteroscope according to the features of kidney cystic lesions ,and investigate the value and clinical application prospectofureteroscopeinthe managementofkidneycysticlesions.Methods:FromMar.2008toDec.2013,70ca-ses of kidneycysticlesions weresubjectedto minimallyinvasivetunnel byusingholmiumlaserandincisiondrainage. For32casesofperipheralrenalcysts,thecysts werelocatedinthefrontofandventraltotherenalpelvis whichwas pushedtothedorsalsurfacein15cases,andthesurgicalapproachfromskintorenalpelvisandthentocyst wascho-sen;and those behind and dorsal to the renal pelvis which was pushed to the ventral surface in 17 cases ,and the sur-gicalapproachfromskintocystandthentorenalpelviswaschosen.For38casesofparapelviccysts,therewere18 casesofcystslocatedintheupperpoleofthekidney,andthesurgicalapproachfromurethratorenalpelvisandthen tocyst withureteroscope waschosen;there were20casesofcystslocatedinthe middleandthebottomofthekid-ney,andthesurgicalapproachfromurethratorenalpelvisandthentocystwithflexibleureteroscopewaschosen. Thecysticdiameterswerefrom4.5to7.0cmwiththeaverageof5.75cm.Forty-ninecasescomplainedofpain symptomsontheloinandback.Twenty-onecaseshavingnosymptoms werepresentedinphysicalexamination.All the cases were diagnosed as renal cysts undergoing B ultrasound ,I UV,CT and MRI preoperatively .Double J stent was placed post-operation .Results:All the operations were successfully carried out .The operative ti me was fro m 30 to90 minwiththeaverageof60 min.Theintraoperativebloodloss was5to100 mLwiththeaverageof52.5 mL. There were no conversions to open surgery,vascular injury and accidental injury.Urethral catheter ,nephrostomy tube and double J tube were pulled out 2 days ,5 to 7 days and 2 months after the operation respectively .The nephr-ostomyhealedafter24handhadnourinaryfistulaandextravasation.Thehospitalstaywas5to9days withtheav-erageof7days.Duringthefollow-upperiodof3to24 months,BultrasoundorCTexaminationrevealedthat68ca-ses had no recurrence and only t wo patients had a recurrence with the cystic dia meter less than 2 .0 c m.Ureteroscopy confir med cystic incision drainage closed again .Conclusions:The individualized surgical approach according to the fea-turesofkidneycysticlesionsbyusingholmiumlaserandincisiondrainage withureteroscopeisanewminimallyinva-sive method withsafety,efficiency,lessinjury,andlowrecurrence.It'stheexpandof ureteroscopyandhas moread-vantages over other treat ments .