Department of Urology, The First People's Hospital of Huzhou, Huzhou, China.
J Endourol. 2019 Nov;33(11):881-886. doi: 10.1089/end.2019.0515.
The aim of this research was to verify the efficacy and complication of flexible ureteroscopic holmium laser incision for simple renal cysts (SRCs). We retrospectively reviewed 116 patients who not only had done flexible ureteroscopic holmium laser incision or laparoscopic decortication for SRC in our institution but also had sufficient data: preoperative information and >1-year follow-up records. The following variables were recorded: age, gender, side, cyst size, location (upper pole, lower pole, and interpolar), blood loss, operative duration, complications during and after surgery, pathology report, and presence or absence of flank pain. The primary endpoint was the efficacy of the treatment; secondary endpoints were safety, pain, and the resolution of other complications. All patients underwent radiologic imaging of the kidneys with a repeated CT, before the operation, 3 and 12 months after surgery. If there were no cysts on the most recent imaging, we defined it as a radiologic success. No statistically significant difference in the background variable in patients of group A (64 patients, flexible ureteroscopic holmium laser incision) and group B (52 patients, laparoscopic decortication) was found, including age, gender, cyst's side, cyst's location, and cyst size before the operation. There were less blood loss by surgeons' evaluation and shorter operative duration ( < 0.001) in group A. In group A, there were three patients who had failed in the first time of operation (two patients failed to place flexible ureteroscope through ureter because of ureteral stricture, and one patient was unable to find the renal cyst in the view of flexible ureteroscope), and no severe postoperative complication was observed. The number of postoperative radiologic failure was five at 3 months and three at 12 months in group A, whereas all the procedures were completed laparoscopically, and no conversion was necessary for group B. But there was one patient who had obvious hematuresis for 1 month after the operation and then it was resolved spontaneously at 3 months. There was only one patient who had a radiologic failure in group B, with the cyst of ∼2 cm at 3 months, and his cyst cannot be seen in CT imaging at 12 months without further treatment. There was no statistically significant difference in the rate of effective operation and complication between the two groups. The operation of flexible ureteroscopic holmium laser incision for SRC had the advantages of less blood loss, short operation time, with a similar rate of operative success and radiologic success after the operation, compared with the process of laparoscopic decortication. It was a good option for urologists to deal with endogenous renal cysts.
本研究旨在验证软性输尿管镜钬激光切开术治疗单纯性肾囊肿（SRCs）的疗效和并发症。我们回顾性分析了 116 例在我院接受软性输尿管镜钬激光切开术或腹腔镜去顶术治疗 SRC 的患者，这些患者均有足够的数据：术前信息和 >1 年的随访记录。记录了以下变量：年龄、性别、侧别、囊肿大小、位置（上极、下极和两极之间）、出血量、手术时间、手术中和手术后的并发症、病理报告以及是否存在腰痛。主要终点是治疗效果；次要终点是安全性、疼痛和其他并发症的缓解。所有患者均在术前、术后 3 个月和 12 个月进行了肾脏影像学检查（重复 CT）。如果最近的影像学检查没有囊肿，则定义为影像学成功。组 A（64 例，软性输尿管镜钬激光切开术）和组 B（52 例，腹腔镜去顶术）患者的背景变量无统计学差异，包括年龄、性别、囊肿侧别、囊肿位置和术前囊肿大小。组 A 的术中出血量较少，手术时间较短（ < 0.001）。组 A 中有 3 例患者首次手术失败（2 例因输尿管狭窄无法放置软性输尿管镜，1 例无法在软性输尿管镜下找到肾囊肿），未观察到严重的术后并发症。组 A 中有 5 例患者在术后 3 个月时影像学治疗失败，3 例患者在术后 12 个月时影像学治疗失败，而所有患者均在腹腔镜下完成了手术，组 B 无需转换手术方式。但有 1 例患者术后 1 个月出现明显血尿，3 个月后自行缓解。组 B 中有 1 例患者影像学治疗失败，3 个月时囊肿约 2cm，12 个月时 CT 未见囊肿，无需进一步治疗。两组有效手术率和并发症发生率无统计学差异。与腹腔镜去顶术相比，软性输尿管镜钬激光切开术治疗 SRC 的优点是术中出血量少、手术时间短，术后手术成功率和影像学成功率相似。这是泌尿外科医生处理内生性肾囊肿的一个不错的选择。
