3种手术方法治疗肾囊肿的对比研究(附98例报告)

A comparison of three procedures for renal cysts(Report of 98 cases)

目的 比较经皮肾囊肿穿刺留置导管硬化治疗、小切口肾囊肿去顶术、经腹腔镜肾囊肿去顶术3种手术方法的优缺点,探讨肾囊肿手术方法的选择. 方法 回顾分析2003年1月-2006年12月在我院应用3种方法治疗98例肾囊肿的临床资料,比较3种方法的手术时间、治疗费用、治愈率等. 结果 穿刺组治疗费用(1030.5±319.5)元最少,治愈率(70%,14/20)最低;小切口组手术时间(45±6)min最短;腹腔镜组治疗费用(8020.5±1060.5)元最高,以上指标3组间差异有显著性(P<0.05).小切口组和腹腔镜组治愈率均为100%,无复发病例,出血量和治愈率等指标差异无显著性(P>0.05). 结论 3种方法各有独特优势,应根据具体情况选择最佳手术方法.直径<7cm的单纯性薄壁浅表肾囊肿,若病人全身情况或经济条件较差可选择穿刺留置导管硬化治疗:肾下极或肾中部背侧单纯性薄壁浅表囊肿可首选小切口肾囊肿去顶术;其他肾囊肿特别是双肾多发囊肿、巨大囊肿及不能排除恶性者应首选腹腔镜肾囊肿去顶术.

Objective To evaluate advantages and disadvantages of three procedures: percutaneous ethanol injection, small incision unroofing, and laparoscopic unroofing-in the treatment of renal cysts. Methods Clinical data of 98 cases of renal cysts from January 2003 to December 2006 were analysesed, treated either by percutaneous ethanol injection (Percutaneous Group), or small incision unroofing (Small Incision Group), or la-paroscopic unroofing (Laparoscopic Group) were reviewed. The operation time, intraoperative blood loss, hospitalization costs, and cure rate were compared among the three procedures. Results The Percutaneous Group presented the least hospitalization costs (1030.5±319.5)yuan, the lowest cure rate (70%,14/20). The Small Incision Group had the shortest operation time (48±6min), and the Laparoscopic Group had the highest hospitalization costs (8020.5±1060.5yuan). There were significant differences in these parameters among the three groups (P<0.05).Both Small Incision Group and Laparoscopic Group showed a cure rate of 100% without recurrence. There were no significant differences in blood loss and cure rate between these two groups (P>0.05). Conclusion The three procedures, with each having its own advantages, should be selected depending on individual conditions. For patients with a simple superficial renal cyst<7 cm in diameter and poor physical states or economic conditions, percutaneous ethanol injection is recommended; small incision unroofing can be employed for a simple superficial renal cyst located at the lower pole or the middorsal part of the kidney; laparoscopic unroofing is suitable for other types of renal cysts, especially bilateral multiple renal cysts, giant cysts, and cysts indistinguishable from renal cancer.