改良法超声引导下无水乙醇介入治疗肾囊肿疗效观察

Effect of Improved Absolute Ethanol Intervention under the Guidance of Ultrasonography on Renal Cyst

目的观察改良无水乙醇超声介入治疗肾囊肿的疗效。方法将384.例肾囊肿患者随机分成3组:传统组(120例)在超声引导下抽净囊液后,注入<50%抽出囊液量的无水乙醇(最多不超过60 ml),静置5～10 min后抽净;保留组(125例)在传统组治疗的基础上,抽净囊腔内液体,最后注入5～10 ml无水乙醇永久保留;改良组(139例)抽净囊液后,在患者可以耐受的情况下注入>50%抽出囊液量的无水乙醇(最大量控制在150 ml),然后利用"漩涡法"对囊腔进行硬化治疗,最后抽净注入液。观察3组患者术后12个月的疗效及并发症发生情况。结果治疗后12个月,3组患者疗效间差异有统计学意义(P<0.01)。3组囊肿直径<10 cm的患者,术后12个月疗效间差异有统计学意义(P<0.01);而囊肿直径≥10 cm的患者,3组疗效间差异无统计学意义(P>0.05)。术后12个月,改良组并发症发生率为12.2%(17/139),传统组为15.8%(19/120),保留组为30.4%(38/125),3组并发症发生率间差异有统计学意义(P<0.01);改良组和传统组并发症发生率与保留组比较,差异均有统计学意义(P<0.01)。结论改良无水乙醇超声介入治疗肾囊肿,在用量上采用"大剂量法",在方式上采用"漩涡法",在时间上采用"非保留法",其疗效优于传统的超声介入治疗方法,且更加安全。

Objective To observe the therapeutic effect of improved intervention method with absolute ethanol under the guidance of Color Doppler ultrasonography in treatment of renal cyst. Methods Totally 384 patients with renal cyst were randomly divided into three groups. The liquid in the cyst of the patients in traditional group （n=120） was drawn out under the guidance of ultrasonography; absolute ethanol of less than 50 percent of the drawn liquid （maximally 60 ml） was infused into the cyst, then the ethanol was drawn out 5 to 10 minutes later. The patients in the retained group （n=125） were treated like those in the traditional group; however the volume of the infused ethanol was 5-10 mL, and the ethanol was kept forever in the cyst. The patients in the improved group （n=139）, after the liquid being drawn out, were given absolute ethanol infusion of more than 50 percent of drawn liquid （within tolerance of the patient and 150 ml maximally）, then the sclerosing therapy was given for the cyst cavity by “eddying method”, finally the infused ethanol was drawn out. The effects 12 months after surgery and complications among three groups were compared. Results Twelve months after surgery, the effects among the three groups showed significant difference （P〈0.01） . The effects of the patients whose cyst＇s diameter〈10 cm among the three groups showed significant difference （P〈0.01） ; but the effects of the patients whose cyst＇s diameter≥10 cm showed no significant difference （P〉0.05） . The incidence rate of complications was respectively 12.2% （17/139） in the improved group, 15.8% （19/120） in the traditional group and 30.4% （38/125） in the retained group, with a significant difference among the 3 groups （P〈0.01） ; and the complication rates in the two non-retained groups were significantly different from that in the retained group （P〈0.01） . Conclusion The improved absolute ethanol intervention, being “high in dose”, “eddying” in operation and “non-retention” in time, has a better effect than that of traditional ultrasonographic intervention in treatment of renal cyst, and it is safer.