经后腹腔两种不同入路腹腔镜治疗单纯性肾囊肿

Laparoscopic decortication of simple renal cysts:a comparison between the retroperitoneal and enlarged perirenal space approaches

目的:评价经后腹腔入路和经肾周筋膜内入路腹腔镜单纯性肾囊肿去顶术的临床疗效。方法:回顾性分析经后腹腔两种不同入路腹腔镜去顶术45例患者的临床资料,比较两组术式手术时间、术中出血量、留置引流管的时间、术后住院时间、以及术者对手术的满意程度等指标。结果:45例患者均顺利完成手术,无中转开放,术中术后无明显并发症。经肾周筋膜内入路组在手术时间要优于后腹腔入路组(P<0.05),两组在术中出血量、留置引流管的时间、术后住院时间等方面,差异无统计学意义。χ2检验提示,手术者对经肾周筋膜内入路组手术满意程度低于后腹腔入路组(P<0.05)。结论:两种入路行腹腔镜单纯性肾囊肿去顶术各有优缺点,最终的术式选择需根据囊肿的部位以及手术者对不同入路的手术技巧差异和熟悉程度等多方面来考虑。

Objective:To compare and investigate the clinical effectiveness of laparoscopic decortication of simple renal cysts through the retroperitoneal and enlarged perirenal space approaches.Methods:We retrospectively analyzed the data of 45 patients with simple renal cysts from May 2010to December 2012in our hospitals.A total of 19 patients underwent laparoscopic decortication thought enlarged perirenal space approaches and 26patients underwent routine retroperitoneal approach.Preoperative characteristics,intraoperative blood loss,operation time,time of drainage removal,postoperative hospital stay and the degree of patient's satisfaction to the operation procedure were documented.Results:All operations were successfully completed.No significant complication was noticed.The laparoscopic decortication through enlarge perirenal space approach had shorten operation time(P<0.05).There was no significant difference in preoperative characteristics,intraoperative blood loss,time of drainage removal and postoperative hospital stay between the two groups.Compared to the enlarged perirenal space approaches group,Pearson's chi-square test indicated a higher degree of surgeon's satisfaction to the operation procedure was noted in the retroperitoneal approach group(P<0.05).Conclusions:The laparoscopic decortication through enlarge perirenal space approach is a good clinical explosion.Each procedure of laparoscopic decortication had its merits and demerits.The final decision is individualized and is,in fact,a consensus based upon the location of the cysts as well as the surgeon's skill and proficiency of procedure and so on.