后腹腔镜与小切口肾囊肿去顶术治疗肾囊肿的对比研究

Comparison of Retroperitoneal Laparoscopic and Small Incision Decortication for the Treatment of Renal Cyst

目的:比较和评价后腹腔镜肾囊肿去顶术和小切口肾囊肿去顶术的治疗效果,探讨肾囊肿微创治疗的手术方式。方法:回顾性分析2006年6月-2011年10月98例有症状的单纯性肾囊肿手术患者治疗的临床资料。56例采用后腹腔镜肾囊肿去顶术,42例采用小切口肾囊肿去顶术。术中均采用了自行研制的实用腹膜后腔扩张器扩张腹膜后腔。记录并比较两组手术资料。结果:两组手术均去顶获得成功。后腹腔镜组症状缓解率91.1%(51/56),小切口手术组92.9%(39/42),随访2～4个月两组均无囊肿复发。两组比较差异无统计学意义(P>0.05)。后腹腔镜组术中出血量、切口长度、术后发热时间、术后肠蠕动恢复时间、术后引流管时间、并发症发生率均优于小切口手术组(P<0.01)。但后腹腔镜组住院费用明显高于小切口手术组(P<0.01)。两组手术时间、下床活动时间、留置尿管时间、住院时间的比较差异无统计学意义(P>0.05)。结论:后腹腔镜肾囊肿去顶术和小切口肾囊肿去顶术都是治疗肾囊肿较为理想的微创手术方式。后腹腔镜较小切口肾囊肿去顶术具有创伤小、出血少、痛苦小、并发症少、适应证宽的优点,是肾囊肿去顶术的首选术式。小切口肾囊肿去顶术手术具有直视下操作、简单易学、无需特殊设备、手术费用低、无复发等优点,但适应证相对狭窄。适合在基层医院推广应用。

Objective： To compare and evaluate the therapeutical effects of retroperitoneal laparoscopic and small incision renal cyst decortication, and to discuss the minimally invasive surgical methods for the treatment of renal cyst.Methods： From June 2006 to October 2011, a total of 98 patients were diagnosed with simple renal cysts.56 patients underwent retroperitoneal laparoscopic （RPL） and 42 patients underwent small incision （SI） renal cyst decortication respectively. Demographic, surgical and pathological outcomes were compared between patients undergoing RPL vs SI renal cyst decortication.Results： All procedures were finished successfully without cyst recurrence after a 2-4 month follow-up.The percentage of symptomatic relief was 91.1%（51 out of 56） in RPL group and 92.9% （39 out of 42） in SI group respectively, and the curative effects were similar between the two groups （P〉0.05）.Estimated blood loss, incision length, recovery time of intestinal function and postoperative complications were significantly less in the RPL group（P〈0.01）.The hospitalization cost in RPL group was significantly higher than that in SI group.However, the two groups were not significantly different from each other （P〉0.05） in operative time, out of bed time, the retention time for urinary drainage tube and hospital stay.Conclusion： Both retroperitoneal laparoscopic and small incision renal cyst decortication are ideal minimally invasive methods in the treatment of renal cyst.Retroperitoneal laparoscopic decortication is the optimal choice because of its less blood loss, less trauma and pain, and less postoperative complications and wider indication.Small incision decortication has the advantages of optic operation, easy learning, no requirement of special equipment, lowerhospitalizationcost.Therefore, it is worthwhile to promote in primary hospitals.