腹腔镜联合肾盏切开取石术同期治疗肾盂旁囊肿合并肾结石的技术要点

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ABSTRACT：ObjectiveTo explore the eficacysafety，and technical advantages of laparoscopic combined with calyceal lithotomyin the simultaneous treatment of parapelviccystwithrenal calculi.MethodsTheclinical dataof two patients diagnosedwithparapelviccystandrenalcalculi inourhospital wereretrospectivelyanalyzed.Bothpatientsreceived transabdominal laparoscopic excisionof parapelviccystand calycealithotomyunder general anesthesia.Preoperative CT plus intravenous pyelography（IVP）was performed tolocalize thecalculi within therenalcalyx.During operation，thecyst wall was disectedand exposedusinganultrasonicsalpel，followedbyincisionof tecstwall，aspirationofcysticfluid，andecisionof redundantcyst wall.Methyleneblue was instiled through theureteralcatheter tomarktherenalpelvisandcalyces，followed by incisionof the targetcalyx andextractionof thecalculi.Thechangesof thecystsand calculi were analyzed.Operationtimeand complications were recorded.ResultsBoth patients were admiteddue torecurrentrightflank painas thechief complaintand werediagnosed withrightrenal multiplecalculi complicatedwith hydronephrosis and parapelviccysts through preoperative imaging examinations.The parapelvic cyst measured approximately 6.4cm×5.3cm and 4.5cm×4.1cm ，respectively. The operations weresuccesfullycompleted without majorcomplications such as hemorrhage or infection.The operationtime was 180andl25 minutes，respectively.Postoperativeultrasoundandabdominal plainfilmconfirmedcompleteresolutionof cystsand calculi.During the2-year folow-up，both patients experiencedcompleteresolutionofflank pain withnorecurrenceofcystsor calculi.ConclusionTransabdominallaparoscopiccombined with calyceal lithotomyisasafeand feasible technique for synchronous treatmentof parapelvic cysts with renal calculi，offering advantages suchas minimal trauma，rapid postoperative recovery，and low recurrence rates.This procedure should be performed in patients with parapelvic cysts larger than 4cm ： Intraoperativeureteralcatheterization with methylene blue infusionisutilizedtodelineate therenal pelvisandcalyces，which is combined with preoperative imaging findings to assst in precise stone localization.

KEY WORDS： parapelvic cyst; renal calculi; laparoscope; calyceal lithotomy摘要：目的探讨经腹腹腔镜肾盂旁囊肿切除联合肾盏切开取石术同期治疗肾盂旁囊肿合并肾结石的疗效、安全性及技术优势。（剩余5613字）