目的：探讨超声引导注射亚甲蓝注射液定位囊肿在输尿管软镜肾盂旁囊肿治疗中应用的安全性和有效性。方法：回顾性分析2017年2月–2019年12月收治的13例输尿管软镜定位困难的肾盂旁囊肿的临床资料,其中男6例,女7例。年龄27~65岁,平均（53.4±9.5）岁。均为单侧单发肾盂旁囊肿,囊肿直径2.9~6.4 cm,平均（5.0±1.2）cm。13例患者囊肿均压迫肾盂肾盏,5例并发同侧肾结石,2例存在腰痛症状。13例患者均行肾盂旁囊肿经尿道输尿管软镜激光切开内引流术,术中患者均取斜仰卧截石位。13例患者输尿管软镜直视下无法明确定位囊肿,均应用超声引导向囊腔内注射亚甲蓝进行染色定位,再以钬激光对被染色的肾盂旁囊肿进行切开内引流,开窗直径1~2 cm,使囊腔与肾盂相通,并于囊腔内留置双J管。结果：手术均成功,术中平均囊肿处理时间（17.9±5.6）min,术中均未出现并发症,术后1例合并结石的患者出现发热,经抗生素治疗后体温降至正常,余患者术后未出现并发症,2例腰痛患者术后腰痛消失。术后平均住院（4.1±3.1）d。术后随访3~12个月,11例（84.6%）囊肿消失,2例（15.4%）囊肿明显缩小,未见囊肿复发。结论：在输尿管软镜处理肾盂旁囊肿过程中,对于输尿管软镜下无法明确定位囊肿位置的肾盂旁囊肿,应用超声引导注射亚甲蓝对囊肿进行染色定位安全可行,短期疗效确切。

Objective： To investigate the safety and effectiveness of ultrasound-guided injection of methylene blue locating cysts in flexible ureteroscopy （fURS） for treatment of parapelvic cysts.Methods： A retrospective study was performed on the clinical data of 13 cases of parapelvic cysts, which were difficult to locate with flexible ureteroscopy, from February 2017 to December 2019. There were 6 males and 7 females, with an average age of （53.4±9.5） years old. All lesions were unilateral parapelvic renal cysts, with a cyst diameter of 2.9-6.4 cm （mean 5.0±1.2 cm in diameter）. The cysts of 13 cases oppressed the renal pelvis and calyces, 5 patients had ipsilateral renal stones, and 2 patients were symptomatic with flank pain. All patients were treated with transurethral fURS internal cyst drainage. The operation was done in all patients in the oblique supine lithotomy position. The cyst could not be clearly positioned under fURS. The methylene blue was injected into the cyst cavity for staining and positioning, and then the peripelvic cyst was decorticated with holium laser to drain the cyst to the pelvis. A 1-2 cm window was created, the cyst cavity is communicated with the renal pelvis, and the proximal end of a double-J stent was placed in the cystic cavity to facilitate internal drainage.Results： All operations were successfully done with no intraoperative complications. One patient with stones developed fever after the operation, and his body temperature dropped to the normal level after antibiotic treatment. The mean operation time was （17.9±5.6） min. The remaining patients did not have complications after the operation. The mean hospital stay was （4.1±3.1） days. After 3-12 months of follow-up, the cysts in 11 patients （84.6%） disappeared, those in 2 patients （15.4%） were significantly reduced, and no patient experienced recurrence.Conclusions： In the process of flexible ureteroscopy for the treatment of parapelvic cysts, it is safe and feasible to use ultrasound-guided injection of methylene blue to stain and position the cysts.