探讨术前三维重建及术中超声引导在肾盂旁囊肿输尿管软镜内切开术中的应用价值。

2017年7月至2018年12月我院采用输尿管软镜钬激光内切开治疗肾盂旁囊肿13例，男性8例，女性5例，平均年龄（55±5）岁，左侧7例，右侧6例。术前基于CT三维重建预先规划目标盏及理想切开位点，并以术中超声实时引导和监测，选择囊肿受压变形最大即囊壁最薄处，配合呼吸暂停切开囊壁，进镜观察囊腔内无误后，扩大切开范围直至肾盏穹窿部，术毕留置双J管。

13例患者手术均顺利完成，最佳切开位点均位于肾盏或肾盏颈而非肾盂，手术时间24～67 min，平均38 min，无中转开放手术者，无严重并发症发生，术后住院2～4 d，平均3 d。术后随访3～21个月影像学检查结果示10例囊肿消失，3例囊肿直径较术前缩小1/2以上，3例合并肾结石患者术后1个月复查未见明显结石残留，7例腰背部酸胀患者术后明显缓解。

输尿管软镜联合钬激光在术前三维重建及术中超声引导下治疗肾盂旁囊肿是安全可行的，且切开位置合适，切开范围充分，出血少，镜下寻找快速，手术安全性高，值得推广。

To explore the value of preoperative three-dimensional reconstruction and intraoperative ultrasound in the treatment of flexible ureteroscope for the treatment of renal parapelvic cysts.

From July 2017 to December 2018, 13 patients with paracentral cysts were treated with ureteroscope and holmium laser incision. There were 8 males and 5 females with an average age of (55±5) years, 7 patients on the left side and 6 cases on the right side. Preoperative planning of target sputum and ideal incision site based on CT three-dimensional reconstruction before operation, and guided and monitored by intraoperative ultrasound in real time, the cystic deformation of the cyst was the largest, that was, the thinnest part of the capsule wall, and the sac was used to cut the wall of the capsule. After observing the cystic cavity in the mirror, the incision range was expanded to the renal pelvis, and the double J tube was left after the operation.

All the 13 patients underwent surgery successfully. The best incision sites were located in the renal pelvis or renal pelvis rather than the renal pelvis. The operation time was 24-67 minutes, with an average of 38 minutes. There was no open surgery, no serious complications occurred, and hospitalized 2-4 days after operation, with an average of 3 days. After 3 to 12 months of follow-up, 10 cases of cysts disappeared, 3 cases of cysts were reduced more than 1/2, 3 cases of patients with renal calculi did not found obvious residual stones after 1 month of operation, 7 cases with back sore and swolley were significantly relieved after surgery.

Ureteroscopy combined with holmium laser in the treatment of pre-renal cysts under the guidance of three-dimensional reconstruction and intraoperative ultrasound is safe and feasible, and the incision position is preferred, the incision range is sufficient, the bleeding is less, the microscope is quick to find, and the operation is safe, and worth to be promote.