腹腔镜经腹腔和腹膜后途径治疗肾囊肿比较

Clinical study of transperitoneal and retroperitoneal laparoscopic approach in the treatment of renal cysts:Report of 145 cases

目的总结腹腔镜经腹腔、腹膜后途径治疗肾囊肿的临床经验。方法对67例经腹腔、78例经腹膜后腹腔镜肾囊肿去顶术的临床资料进行统计分析,比较两种方法的手术时间、术中失血量、术后开始进食时间和住院天数等的差别。结果经腹腔途径和经腹膜后途径两组手术全部成功,手术时间分别为(30．5±9．7)min和(41．5±5．8)min(P＞0．05);术中出血量分别为(20±5．3)ml和(25±4．2)ml(P＞0．05);术后开始进食时间分别为(19±6．7)h和(12±3．7)h(P＜0．05);患者术后开始下床活动时间平均(18±1．2)h和(16±2．9)h(P＞0．05)。两组中无中转开放手术和输血者,经腹膜后组1例术后出现肾周感染并发热,1例发生皮下气肿,1例发生腹膜穿孔,1例术后病检为恶性,术后第7天行开放肾癌根治术。所有患者随访3～20个月,无复发者。结论腹腔镜经腹腔、腹膜后途径肾囊肿去顶术创伤小、恢复快,方法简单;选用何种路径,应根据术前CT定位、操作熟练程度和患者体形等来综合判断。

Objective To evaluate the clinical value of transperltoneal, retroperitoneal laparoscopic approach in the treatment of renal cysts. Methods The clinical data of 145 cases of renal cysts treated by transperitoneal （67 cases） and retroperitoneal laparoscopic （78 cases） approach were analysed. The difference of the two groups on operation tlme,average bleeding volume during operation,time of beginning to take food and to move after operation were compared.Results The transperitoneal, retroperitoneal laparoscopic operations were all successful.The operation time were 30.5±9.7min and 41.5±5.8min （P〉0.05）. The average bleeding volume were 20＋5.3ml and 25±4.2ml （P〉0.05）. The time of beginning to take food were19±6.7h and 12±3.7h （P〈0.05）, and the time of beginning to move were 18± 1.2h and 16 ±2.9h （P〉0.05）.No cases undenvent open operation and blood transfusion. Of the retroperitoneal laparoscopic approach group, there were three complications,including kidney peripheral infection and high fever in one case,hypodermic emphysema in one case, and peritoneum perforation in one case; and one case which was confirmed malignant tumor by pathology was eradicated by open operation on the first day after the first operation.All of the cases were followed up for 3-20 months, and there was no relapse.Conclusion Transperi-toneal or retroperitoneal laparocoplc surgery in the treatment of renal cysts are of minimal injuries, faster recovery and simply manipulation.The operation access is determined by CT before operation, operator＇s skill and patient＇s figure.