带蒂脂肪瓣填塞在后腹腔镜肾囊肿去顶减压术中的应用价值

Clinical Application of Pedicled Fat Flap Plugging in Retroperitoneal Laproscopic Decortication of Renal Cysts

目的探讨带蒂脂肪瓣填塞在后腹腔镜肾囊肿去顶减压术中的应用价值,以减少术后肾囊肿复发,指导临床治疗。方法选取2008年1月—2012年12月开封市中心医院收治的84例肾囊肿患者,根据治疗不同分为：治疗组41例行后腹腔镜肾囊肿去顶减压术＋残腔带蒂脂肪瓣填塞术,对照组43例行后腹腔镜肾囊肿去顶减压术＋残腔碘酊烧灼术。记录并比较两组的手术时间、术中出血量、住院时间、术后并发症及复发率。结果本组84例肾囊肿均成功实施后腹腔镜下手术治疗,无中转开腹手术患者。治疗组手术时间（34.6±3.8）min,术中出血量（24.6±5.4）ml,住院时间（5.2±1.6）d;对照组手术时间（31.6±2.6）min,术中出血量（21.4±4.7）ml,住院时间（5.3±1.5）d,差异均无统计学意义（t值分别为1.178、1.311和0.215,P〉0.05）。两组均无迟发型出血、尿漏和切口感染等术后并发症。术后随访1-6年,平均（3.7±1.5）年,治疗组未见肾囊肿复发,对照组4例复发,复发率为9.3%。结论相比传统的后腹腔镜肾囊肿去顶减压术,应用带蒂脂肪瓣填塞残腔的技术方法易掌握,术后复发率低,值得应用。

Objective To investigate the application valuation of pedicled fat flap plugging in retroperitoneal laproscopic decortication（ RLD） of renal cysts in order to reduce the recurrence of renal cyst and guide clinical treatment. Methods 84 patients with renal cysts admitted to the Central Hospital of Kaifeng from January 2008 to December 2012 were divided into treatment group（ 41 cases） and control group（ 43 cases）. The treatment group was given pedicled fat flap plugging during the process of RLD,while the control group was given traditional laproscopic operation. The operation time,intra- operative hemorrhage,hospital stay,postoperative complication and recurrence rate were recorded and compared between the two groups. Results All the 84 cases had successful laproscopic operation and no case had conversion to open operation. The operation time 〔（ 34. 6 ± 3. 8） min vs.（ 31. 6 ± 2. 6） min〕,intra- operative hemorrhage 〔（ 24. 6 ± 5. 4） ml vs.（ 21. 4± 4. 7） ml〕and hospital stay 〔（ 5. 2 ± 1. 6） d vs.（ 5. 3 ± 1. 5） d〕between the treatment group and control group showed no statistically significant difference（ t = 1. 178,1. 311,0. 215,P〉 0. 05）. No complication like late hemorrhage,urine leakage and wound infection occurred. After a mean follow- up of（ 3. 7 ± 1. 5） years（ ranging from 1 to 6 years）,no cyst recurred in the treatment group and four cases recurred in the control group with a recurrence rate of 9. 3%. Conclusion Compared with traditional method,the pedicled fat flap plugging in RLD of renal cysts is easy to operate,and the recurrence rate is really low,therefore it deserves to be applied.