腹腔镜肾囊肿去顶术与经皮肾囊肿穿刺硬化术疗效比较

Comparison of laparoscopic unroofing with percutaneous sclerotherapy in treatment of renal cysts

目的 比较腹腔镜囊肿去顶术和经皮肾穿刺并无水酒精硬化（PAES）在单纯性肾囊肿治疗中的效果.方法 选取140例单纯性肾囊肿患者,其中行PAES治疗68例（对照组）,行经腹腔镜肾囊肿去顶术治疗72例（观察组）.对比分析两组患者疗效、术后恢复情况及费用等.结果 对照组和观察组的成功率分别为88.2%、91.6%,术后并发症的发生率分别为13.2%、15.3%,平均手术时间分别为（57.7±8.4）、（94.6±11.0）min,平均住院时间分别为（1.0±0.0）、（3.4±0.2）d,平均住院费用分别为（5 017.08±90.62）、（11 698.35±105.76）元,两组患者手术成功率和并发症发生率的差异均无统计学意义（均P ＞0.05）,平均手术时间、平均住院时间及平均住院费的差异有统计学意义（P＜0.01或0.05）.结论 两种方法 各有优势,应根据具体情况选择最佳手术方法.经皮肾囊肿穿刺硬化治疗痛苦小、并发症少、恢复快、费用低,适用于症状性单纯肾囊肿、经济条件有限的患者.其他肾囊肿尤其是双肾多发囊肿、巨大囊肿及不能排除恶性者、以及PAES治疗失败或经皮肾穿刺困难者,则应选择腹腔镜肾囊肿去顶术.

Objective To compare the efficacy of laparoscopic unroofing with percutaneous sclerotherapy in treatment of simple renal cysts. Methods A total of 140 patients with simple renal cysts underwent surgical treatment from October 2008 to January 201068, including 68 cases received percutaneous sclerotherapy and 72 cases received laparoscopy unroofing of cysts. The clinical effectiveness, post-operative recovery and expenditure were compared between two groups. Results The successful rate was 88.2% and 91.6%; the incidence of complications was 13.2% （9/68） and 15,3%（11/72） in sclerotherapy and laparoscopy groups, respectively （both P 〉0.05）. The mean operation time was （57.7 ± 8.4）min and （94.6 ± 11.0）min; the mean length of hospital stay was （ 1.0±0.0）d and （3.4±0.2）d; the mean expenditure was （5 017.08±90.62） Yuan and （11 698.35± 105.76） Yuan in sclerotherapy and laparoscopy groups, respectively （P〈0.01 or P〈0.05）. Conclusion Two methods have their own advantages and disadvantages. Percutaneous sclerotherapy has less suffering and complications, quicker recovery and less medical expenses, which is suitable for patients with simple renal cysts and poor physical states. Laparoseopic unroofing is recommended for bilateral murtiple renal cysts, giant cysts and cysts indistinguishable from renal cancer and cysts failed in sclerotherapy.