腹膜后腹腔镜肾囊肿去顶减压术23例报告

目的:探讨后腹腔镜肾囊肿去顶减压术的临床可行性、安全性及治疗效果;总结围手术期的临床经验。方法:回顾分析2008-2011年来由同一术者完成的23例有临床症状的单个肾囊肿行后腹腔镜肾囊肿去顶减压术患者的围手术期临床资料(包括:围手术期的失血量、手术时间、围手术期的并发症、住院时间)及术后随访临床症状、肾脏超声情况(术后第一年内每6个月复查B超一次,之后每年一次)。结果:23例患者手术均获成功,无患者转开放手术,无围手术并发症发生;平均手术时间为53min(35-72min),平均失血量为36m(l28-45ml),平均住院时间为5.2天(4-7天),平均恢复正常活动时间为15天(10—30天)。在出院后12-42个月的随访过程中,18例患者的腰痛临床症状均完全缓解;5例患者仍诉疼痛,但不需做任何止痛处理。肾脏B超检查原手术部位未见囊肿复发。结论:后腹腔镜肾囊肿去顶减压术是一种安全、有效的治疗有临床症状的肾囊肿的手术方法,该方法创伤小、住院时间短、康复快,术后临床症状改善明显,值得推广。

Objective：The purpose of this study was to present our clinical experience of retroperitoneal laparoscopic decortication（RLD） for patients with symptomatic simple renal cysts.The feasibility,safety and efficacy of this technique is reported,along with immediate and long-term clinical outcomes.Methods：The clinical data of 23 cases were analyzed retrospectively.Over a 2-year period,23 consecutive patients with symptomatic simple renal cysts underwent RLD by a single surgeon.Perioperative blood loss,length of operative procedure,length of hospital stay and complications were analyzed.Follow-up included clinical review and renal ultrasonography,at 6-monthly intervals for 1 year,and then annually.Results：23 cases were operated successfully,no open conversions were required.Mean duration of surgery was 53min（35-72min） and operative blood loss was 36ml（28-45 ml） in all cases.Mean length of hospital stay was 5.2（4-7） days and return to normal activities was achieved after a mean of 15（10-30） days.At a mean follow-up of 26（12-42） months,18 patients（78%） were completely relieved of symptoms,while 5（22%） patients complained of some pain not requiring any analgesia.The follow-up ranged from 12 to 42 months and there was no recurrence.Renal ultrasonography showed no recurrence of the symptomatic renal cyst in all cases.Conclusions：RLD is a safe and effective method to treat symptomatic renal cysts,with an immediate postoperative symptomatic relief,a short convalescence period and effective clinical outcome,and advantages such as less injury,less bleeding,quicker recovery and shorter hospitalization.