Comparison of the clinical efficacy of fenestration and internal drainage in the treatment of endogenous renal cyst under flexible ureteroscope between 1470 nm laser and holmium laser
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摘要: 目的 比较输尿管软镜下1470 nm激光与钬激光治疗内生性肾囊肿的临床疗效及安全性。方法 回顾性分析2016年1月—2020年6月湖州市第一人民医院收治的67例手术患者共101个肾囊肿的临床资料，其中53个肾囊肿采用输尿管软镜1470 nm激光开窗内引流术(1470 nm激光组)，48个肾囊肿采用输尿管软镜钬激光开窗内引流术(钬激光组)。每组按囊肿壁厚度分为薄壁囊肿亚组和厚壁囊肿亚组。所有患者在术前、术后1个月和6个月分别进行肾脏CT影像学检查，并比较两组围手术期安全性、并发症及术后1个月、6个月手术效果。结果 术后两组发热、腰痛等无明显差异，1470 nm激光组术后囊肿血肿更低(0/53 vs.4/48，P=0.048)。1470 nm激光组术中开窗直径显著大于钬激光组[1.9(1.5，2.1) cm vs.1.6(1.3，2.0) cm，P=0.047]，并且在厚壁亚组中1470 nm激光组肾囊肿开窗直径更显著大于钬激光组[(1.77±0.34) cm vs.(1.47±0.34) cm，P=0.003]，而在薄壁亚组中肾囊肿开窗直径两组比较差异无统计学意义。术后1个月和6个月两组囊肿直径较术前均显著性缩小，两组肾囊肿直径无显著性差异，但术后6个月肾囊肿直径有下降趋势[1个月：(1.68±0.66) cm vs.(1.69±0，71) cm，P=0.917；6个月：1.2(0.9，1.6) cm vs.1.3(0.9，2.0)，P=0.119]。在1470 nm激光组和钬激光组的亚组比较中，术后1个月和6个月两组薄壁亚组比较差异无统计学意义[1个月：(1.50±0.67) cm vs.(1.53±0.74) cm，P=0.860；6个月：(1.11±0.48) cm vs.(1.13±0.56) cm，P=0.903]；但在厚壁亚组中，术后6个月，1470 nm激光厚壁亚组囊肿直径显著小于钬激光厚壁亚组[(1.30±0.60) cm vs.(1.96±0.94) cm，P=0.003]。结论 输尿管软镜下钬激光或1470 nm激光开窗内引流术治疗内生性肾囊肿均是比较安全、有效的治疗方法。对于厚壁的内生性肾囊肿，1470 nm激光由于良好的止血作用及术中更大的开窗直径，术后复发率更低，术后远期效果更好。Abstract: Objective To compare the efficacy and safety between flexible ureteroscopic holmium laser incision and flexible ureteroscopic 1470 nm diode laser incision for endogenous renal cyst.Methods The clinical data of 101 independent renal cysts (67 patients) at First People's Hospital of Huzhou City from Jan. 2016 to Jun. 2020 were retrospectively collected and analysed, including 53 renal cysts cases that received 1470 nm diode laser surgery (1470 nm diode laser group) and 48 renal cysts cases that received holmium laser surgery (holmium laser group). Each group was divided into thin-walled cyst subgroup and thick-walled cyst subgroup according to cyst wall thickness. All patients underwent radiological imaging of the kidneys using repeated CTs before surgery and one and six months after surgery. We compared the safety precautions, observation of complications, and surgical outcomes of the two laser groups.Results There were no significant differences in fever or lumbago between the two laser groups after surgery, but intracapsular hematoma was lower in the 1470 nm diode laser group than the holmium laser group (0/53 vs. 4/48,P=0.048). There was significant difference between the two laser groups in the incision diameter of the renal cyst during surgery [1470 nm diode laser group 1.9(1.5, 2.1) cm vs. 1.6(1.3, 2.0) cm,P=0.047]. However, the incision diameter in the 1470 nm diode laser group exceeded the holmium laser group significantly in the thick-walled parapelvic renal cysts subgroup (1.77±0.34) cm vs. (1.47±0.34) cm,P=0.003. The renal cystic diameter of the two groups was significantly reduced one and six months after surgery. There was no significant difference in therenal cystic diameter between the two groups, but therenal cystic diameter decreased 6 months after surgery[1 month: (1.68±0.66)cm vs.(1.69±0, 71)cm,P=0.917;6 months: 1.2(0.9, 1.6) cm vs. 1.3(0.9, 2.0) cm,P=0.119]. The difference was not significant in the diameter of the renal cyst in the thin-walled cysts subgroups between the two laser groups one month and 6 months after surgery[1 month: (1.50±0.67) cm vs. (1.53±0.74) cm,P=0.860; 6 months: (1.11±0.48) cm vs. (1.13±0.56) cm,P=0.903]. However, the diameter of the renal cyst in the thick-walled cysts subgroup treated with the 1470 nm diode laser was significantly lower than the thick-walled cysts subgroup treated with the holmium laser 6 months after surgery[(1.30±0.60) cm vs. (1.96±0.94) cm,P=0.003].Conclusion The use of 1470 nm diode laser or holmium laser surgery under flexible ureteroscope is a safe and effective treatment for endogenous renal cyst. For thick-walled endogenous renal cyst, the 1470 nm diode laser had a lower postoperative recurrence rate and better long-term postoperative effects due to its better haemostatic effect and larger intraoperative incision diameter.
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Key words:
- flexible ureteroscope /
- holmium laser /
- 1470 nm diode laser /
- endogenous renal cyst
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表 表 1 术前两组患者一般资料比较
项目 1470 nm激光组(n=53) 钬激光组(n=48) P值 男/女 31/22 26/22 0.662a) 年龄/岁 60.5(47.3，67.0) 58.0(46.0，63.0) 0.058b) 单侧/双侧肾囊肿数量 30/23 28/20 0.861a) 单发/多发肾囊肿数量 35/18 28/20 0.425a) 肾囊肿位置/例(%) 0.986a) 肾盂部 24(45.3) 22(45.8) 肾上极 10(18.9) 9(18.8) 肾中极 10(18.9) 10(20.8) 肾下极 9(17.0) 7(14.6) Bosniak分级(Ⅰ/Ⅱ) 44/9 4/8 0.313a) 囊肿直径/cm 5.15±0.09 5.22±0.12 0.660c) 合并疾病/例(%) 0.973a) 肾结石 13(24.5) 11(22.9) 局限性肾积水 8(15.1) 9(18.8) 高血压 17(32.1) 14(29.2) 糖尿病 7(13.2) 8(16.7) 冠心病 7(13.2) 6(12.5) 注：a)χ2 test；b)Mann-Whitney U test；c)独立样本t-test。 
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表 表 2 钬激光组与1470 nm激光组手术效果比较及随访
项目 1470 nm激光组(n=53) 钬激光组(n=48) P值 薄壁/厚壁囊肿 22/31 25/23 0.287a) 囊肿开窗直径/cm 1.9(1.5，2.1) 1.6(1.3，2.0) 0.047b) 囊肿直径/cm 术前 5.19±0.68 5.17±0.80 0.885c) 术后1个月 1.68±0.66 1.69±0，71 0.917c) 术后6个月 1.2(0.9，1.6) 1.3(0.9，2.0) 0.119b) 肾囊肿内血肿 0 4 0.048d) 发热 6 5 0.884a) 影像学治疗失败 术后1个月 0 0 — 术后6个月 3 6 0.302d) 注：a)χ2 test；b)Mann-Whitney U test；c)独立样本t-test；d)Fisher's test。
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表 表 3 钬激光组与1470 nm激光组薄壁/厚壁亚组手术效果比较及随访
项目 1470 nm激光组(n=53) 钬激光组(n=48) P值 薄壁囊肿亚组 22 25 囊肿开窗直径/cm 2.00(1.58，2.33) 1.90(1.50，2.10) 0.584a) 囊肿直径/cm 术前 5.25±0.76 5.19±0.84 0.807b) 术后1个月 1.50±0.67 1.53±0.74 0.860b) 术后6个月 1.11±0.48 1.13±0.56 0.903b) 肾囊肿内血肿 0 1 1.000c) 发热 0 1 1.000c) 影像学治疗失败 术后1个月 0 0 — 术后6个月 0 1 1.000c) 厚壁囊肿亚组 31 23 囊肿开窗直径/cm 1.77±0.34 1.47±0.34 0.003b) 囊肿直径/cm 术前 5.15±0.63 5.15±0.78 0.989b) 术后1个月 1.81±0.64 1.86±0.64 0.741b) 术后6个月 1.30±0.60 1.96±0.94 0.003b) 肾囊肿内血肿 0 3 0.071c) 发热 5 4 1.000c) 影像学治疗失败 术后1个月 0 0 _ 术后6个月 2 5 0.213c) 注：a)Mann-Whitney U test；b)独立样本t-test；c)Fisher's test。
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