经皮肾镜同期治疗肾盂旁囊肿合并肾盂输尿管连接部狭窄的临床观察

摘要： 目的??探讨经皮肾镜途径同期治疗肾盂旁囊肿合并肾盂输尿管连接部狭窄（UPJO）的安全性和可行性。方法?选取单侧单发肾盂旁囊肿合并UPJO患者32例，其中并发同侧肾结石25例。合并结石者先行微创经皮途径钬激光碎石术后，经此通道行肾盂旁囊肿钬激光切开内引流术，UPJO行顺行高压球囊扩张术，术后留置海马管引流3～6个月。分析囊肿开窗内引流、狭窄高压扩张手术时间及术后住院时间。结果?患者肾盂集合分离系数术前（55.93±5.85）与术后1个月（46.17±6.33）、3个月（40.47±6.06）、6个月（33.81±7.05）和9个月（28.95±7.92）相比有明显改善，差异有统计学意义（P <0.05）。术后6个月与9个月相比，差异有统计学意义（P <0.05），随着时间的推移，积水分离系数减小。结论?经皮微通道途径同期治疗肾盂旁囊肿合并UPJO，有效缓解临床症状，减低集合系统分离系数，疗效确切，行之安全有效。
Abstract: Objective?To evaluate the efficacy and safety of percutaneous micro-channel approach in treatment of pelvis side cyst and ureteropelvic junction obstruction simultaneously.?Methods?32 patients with unilateral solitary parapelvic cyst complicated with UPJO, including 25 cases with ipsilateral kidney stones. After percutaneous holmium laser lithotripsy for patients complicated with calculi, then performed incision and drainage through the channels for parapelvic cyst by holmium laser, and antegrade high pressure balloon dilatation for UPJO, drainage by hippocampal tube in 3 ~ 6 months postoperatively. The operation time of fenestration drainage of cyst, narrow hypertensive dilatation and postoperative hospital stay were analyzed.?Results?Compared with 1 month (46.17 ± 6.33), 3 months (40.47 ± 6.06), 6 months (33.81 ± 7.05), 9 months (28.95 ± 7.92) after surgery, there was a marked improvement of the separation coefficient of renal convergence, the difference was statistically significant (P < 0.05). And compared with 6 months after surgery, the data of 9 months after surgery has statistical significant differences (P < 0.05). The separation coefficient of renal convergence decreases as time goes on.?Conclusions?Percutaneous micro-channel approach in treatment of pelvis side cyst and ureteropelvic junction obstruction by the same time can effectively relieve symptoms and decrease the separation coefficient of renal convergence. It is safe and effective.