多囊肾成人患者应用后腹腔镜肾囊肿去顶减压术的临床研究

Clinical study of renal cyst top removeing decompression with retroperitoneoscopy in adult patients with polycystic kidney

目的研究多囊肾成人患者应用后腹腔镜肾囊肿去顶减压术的临床疗效。方法将我院2010年2月-2013年2月确诊并收治的79例成人型多囊肾患者纳入临床组,本组患者全部实施后腹腔镜肾囊肿去顶减压术,按照分期单侧治疗规则来进行。同时,对我院2008年4月-2009年11月确诊并收治的成人型多囊肾患者共计79份病历资料进行回顾性分析,纳入对照组。对照组病例均通过实施开放性肾囊肿去顶术进行治疗。统计两组手术时间、失血量、肠道功能恢复时间、下床活动时间及住院天数,并对所有患者实施为期15个月的临床随访,对比两组患者收缩压、舒张压、血肌酐、血尿素氮的指标改善情况。结果所有患者均顺利完成手术,患者在术中及术后均未有显著并发症出现。临床组其手术时见、失血量、肠道功能术后恢复时间、下床活动时间及住院件数均显著少于对照组（P〈0.05）。随访期间所有患者腰部酸胀疼痛症状均显著改善或完全消失,实施肾脏彩色多普勒超声检查显示未见囊肿复发。两组手术3个月后血压及肾功均比治疗前显著改善（P〈0.05）,而两组手术3个月后血压及肾功其改善幅度差异无统计学意义（P〉0.05）。结论多囊肾成人患者应用后腹腔镜肾囊肿去顶减压术在保障与常规开腹同等疗效的前提下,其创伤更小、更有利于术后恢复。

Objective To study the clinical effect of renal cyst top removeing decompression with retroperitoneoscopy in adult patients with polycystic kidney. Methods 79 adult patients with polycystic kidney were treated with renal cyst top removeing decompression via retroperitoneoscopy by the unilaterally treatment at different stage in our hospital from February 2010 to February 2013,while the other 79 adult patients with polycystic kidney who were diagnosed and treated with open renal cyst top removeing decompression in our hospital from April 2008 to November 2009 were retrospective analyzed as the control group.To statistically analyzed the operation time,the blood loss,the intestinal function recovery time,the off-bed activity time,and the hospitalization time of the two groups,to compare the improvement of index of systolic pressure,diastolic blood pressure,serum creatinine,and blood urea nitrogen between the two groups after 15 months clinical follow-up. Results All of the patients had completed smoothly the operation without significant intraoperative and postoperative complication.The operation time,the blood loss,the intestinal function recovery time,the off-bed activity time,and the hospitalization time in clinical group were significant shorter than which in control group（P〈0.05）.During the follow up period,the pain symptom of waist had significantly improved or disappeared completely without cyst recurrence which was measured by nephritic color Doppler ultrasonography.The postoperative blood pressure and renal function of the two groups after 3 months had significantly improved compared with before operation（P〈0.05）,while there was no significant differences of the improvement of blood pressure and renal function between the two groups after 3 months（P〈0.05）. ConclusionRenal cyst top removeing decompression with retroperitoneoscopy in adult patients with polycystic kidney has obtained equivalent clinical effect to conventional open treatment,has smaller trauma,and is beneficial to postoperative recovery.