后腹腔镜肾囊肿切除术180例分析

Analysis of 180 cases of retroperitoneoscopic renal cystectomy.

目的 探讨后腹腔镜肾囊肿切除的可行性和并发症。 方法 回顾分析 1995年 4月～ 2 0 0 1年 4月 180例后腹腔镜肾囊肿切除的临床资料。 结果 手术成功 173例 (96 1% ) ,中转开放手术 7例 (3 9% ) ,呈逐年下降趋势。其中 4例 (2 2 % )为解剖复杂 ,暴露囊肿困难 ;2例 (1 1% )为肥胖患者 ,术中腹膜破裂 ,经腹途径操作困难 ;1例(0 6% )为术中肾包膜破裂出血。并发症发生率 3 9% (7例 )其中单纯血肿 2例 ,血肿感染 5例 (2 8% ) ;囊肿位于肾上极 6例 (6/ 66) ,下极 1例 (1/ 42 )。 结论 后腹腔镜肾囊肿切除术失败的主要原因是解剖关系复杂与肥胖 ;最常见的并发症是出血和血肿 。

Objective To investigate the reasons for failure and complications of retroperitoneoscopic renal cystectomy. Methods 180 cases of retroperitoneoscopic renal cystectomy were retrospectively analyzed. Results The procedures were successful in 173 cases(96.1%),7 cases(3.9%)were converted to open surgery,which included 4 cases(2.2%)of complex anatomy,2 cases(1.1%)of obese patients with peritoneotomy before the cysts were dissected,and 1 case(0.6%) of bleeding from the ruptured neurocapsula.The rate of complication was 3.9%(7 cases),which was related to bleeding hematoma,including 2 cases of simple hematoma and 5 cases(2.8%) of hematoma infection.6 cases(6/66)had upper polar cysts and 1 case(1/42)inferios.5 of the patients were cured by punctured under ultrasonic guidance except that 2 cases with infection needed reintervention.Of these 7 cases,2 cases had shock and 1 case had temporary neuropathy,which were cured by conservative methods;2 cases manifested hydrothorax,one of whom received thoracentesis,the other was cured after hematoma was drained;One case had minor hydronephrosis which did not aggravate during 54 months follow-up. Conclusions Most of the conversions were due to complex anatomy and obesity.The maiu complications were bleeding and hematoma,which occurred mostly in upper polar renal cysts.Technical development with improved training and good knowledge of anatomy can further reduce the coversion and complication.