輸尿管鏡併用雷射切除巨大腎旁囊腫之兩例病例報告

陳致豪、黃冠華

奇美醫學中心外科部泌尿科

Ureteroscopic laser incision of huge parapelvic cyst: Two case reports and Review of Literature

Zhi-Hao Chen,, Steven Kuan-Hua Huang

Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

Abstract: Laparoscopic unroofing of renal cysts had become standard surgical option in recent years, especially for simple cyst. However, parapelvic and peripelvic cysts, which were located very near to collecting system, may raise our concern of urine leakage when treated with laparoscopic  resection. Therefore, we presented two cases of ureteroscopic laser incision of huge renal cyst this year.

Case report 1: A 54 years old female, without specific underlying disease, had incidental finding of a right renal cyst, about 9cm in size, which was Bosniak classifcation category I. She underwent ureterosopic laser incision of the renal cyst. The renal cyst was located near upper calyx. A 2cm x  2cm defect of the septum was made during the endoscopic surgery. The volume of drained fluid of renal cyst was 250ml. The cyst fluid was clear and transparent. A JJ stent was placed with the proximal tip inside the cyst. After the operation, the patient was discharged on the following morning. JJ stent was removed smoothly 2 weeks later. Follow-up CT scan showed completely resolved renal cyst without urine leakage.

Case report 2: A 59 years old female, with underlying disease of hypertension, had right flank fullness sensation recently. Sonography and CT scan showed a right parapelvic cyst about 8cm in size, which was Bosniak classifcation category I. She also underwent ureterosopic laser incision of the renal cyst. Incision was made from 12 o’clock to 9 o’clock of the ureteropelvic junction. JJ stent was placed into the cyst. The patient was discharged on post-op day one. We removed her JJ stent a month later. Follow-up CT scan showed partial shrinkage of parapelvic cyst. The size of renal cyst decreased from 8cm to 3cm. No urine leakage was noted.

Conclusions:  Review of previous literature suggested that endoscopic incision of renal cyst was  safe and effective. No skin incision was needed at all. Our initial experience of ureterosopic laser incision of huge renal cysts also yielded the same results.