介入法置管引流并硬化治疗肾囊肿

Treatment of renal cysts with imaging-guided percutaneous catheterization drainage and alcohol sclerosis

目的探讨影像引导下经皮穿刺置管外引流并无水酒精硬化治疗肾囊肿的疗效和安全性。材料与方法对36例(男22例,女14例,年龄18～65岁)原发性肾囊肿患者进行了影像引导下的经皮穿刺置管引流及无水酒精硬化治疗。通过超声或CT引导行肾囊肿穿刺,成功后在透视下注入造影剂进一步确定后,置管外引流并反复注射无水酒精行硬化治疗。结果 36例患者共38个囊腔。上极21个,下极10个,中极7个。囊肿术前长径最大8.5cm,最小4.5cm,平均5.5cm。穿刺38次,入路均自腰背部,成功率100%。放置5F多侧孔导管12根,7F引流管26根。经引流管共注射无水酒精169次,平均4.45次,平均每次的用量约25ml。随访1～6年,平均3.5年。除1例多囊肾的单个囊肿为有效外,其余37个囊肿全部消失,治愈率为97%,无严重并发症发生。结论介入法经皮穿刺置管引流并酒精硬化术治疗肾囊肿,成功率和治愈率高,并发症少。

Objective To investigate the effect and safety of imaging-guided percutaneous catheterization drainage and alcohol sclerosis for treatment of renal cysts. Methods Thirty-six patients with primary renal cysts, including 22 men and 14 women aged 18-65 years （mean 42.5 years）, were treated with imaging-guided percutaneous puncture catheterization drainage and alcohol sclerosis treatment. The location of the renal cysts and puncture route, angle and depth were determined by ultrasound or CT scan. Paracentesis and catheterization external drainage were carried out under fluoroscope. Absolute alcohol was used as the sclerosis agent. Results Thirty-eight cysts were detected in the 36 patients, locating at the upper pole （n=21）, subtus pole （n=10） and intermediate pole （n=7）. The length of renal cysts was 4.5-8.5 cm （mean 5.5 cm）. Puncture was performed through the lumbar back and the success rate was 100%. Thirty-eight multi-lateral holes 5-7F drainage catheters were placed in the 38 cysts. Alcohol was injected for 169 times through the drainage tube and the average volume was 25 ml, with an average injection of 4.45 times. During the follow-up for 1 to 6 years （mean 3.5 years）, 37 renal cysts disappeared and 1 cyst was reduced in a patient with polycystic kidney. The total cure rate was 97% in this series, and no serious complications occurred after the operation. Conclusion Imaging-guided percutaneous puncture catheterization drainage and alcohol sclerosis is effective and safe for treatment of renal cysts.