经皮穿刺囊内入路电切去顶术与腹腔镜下肾囊肿去顶术治疗单纯性肾囊肿的疗效对比

Comparison of percutaneous resection and laparoscopic deroofing of renal cysts

目的比较经皮囊内入路电切去顶术和腹腔镜下肾囊肿去顶术治疗单纯性肾囊肿的疗效。方法回顾性分析2013年10月至2016年6月收治的39例行肾囊肿去顶术患者的临床资料，所有患者术前均行超声及CT检查证实为单纯性肾囊肿。其中电切镜组17例，年龄34～81岁，平均57岁；囊肿直径5.4～8.2 cm，平均6.4 cm；术前血肌酐（SCr）38.1～108.8 μmol/L，平均66.5 μmol/ L；术前血钠135.6～145.1 μmol/L，平均141.5 μmol/L；术前血钾3.4～4.7 μmol/L，平均4.0 μmol/L。行经皮囊内入路电切去顶术，术中在超声定位下应用经皮肾穿刺技术配合双极电切镜切除囊壁。腹腔镜组22例，年龄46～73岁，平均60岁；囊肿直径4.3～8.9 cm，平均6.8 cm；术前SCr 48.6～141.9 μmol/L，平均74.8 μmol/L；术前血钠135.0～146.1 μmol/L，平均141.4 μmol/L；术前血钾3.1～4.8 μmol/L，平均4.0 μmol/L。行经腹膜后入路三孔法腹腔镜下囊肿去顶减压术，术中利用超声刀切除囊壁。比较两组的手术时间、术中出血量、术后住院时间、术后引流管留置时间、术后电解质变化等指标。结果39例手术均顺利完成，无中转开放手术者。电切镜组手术时间15～50 min，平均29.7 min；术中出血量10～80 ml，平均35.4 ml；术后引流管留置时间1～3 d，平均2.3 d；术后住院时间2～5 d，平均3.7d；术后SCr 43.8～95.5 μmol/L，平均67.4 μmol/L；术后血钠136.0～147.2 μmol/L，平均141.2 μmol/L；术后血钾3.2～4.3 μmol/L，平均3.8 μmol/L。2例术后出现腹水，均为腹侧肾囊肿患者，术中腹膜无明显破损，考虑为灌注液经腹膜渗透至腹腔，于左下腹行腹腔穿刺，置管引流1 d后治愈。腹腔镜组手术时间20～100 min，平均63.0 min；术中出血量10～200 ml，平均60.4 ml；术后留置引流管时间2～5 d，平均3.1 d；术后住院时间2～16 d，平均5.1 d；术后SCr 46.5～157.6 μmol/L，平均68.9 μmol/L；术后血钠136.0～147.2 μmol/L，平均141.6 μmol/L；术后血钾3.3～4.3 μmol/L，平均3.8 μmol/L。2例术后发热，予抗感染、对症治疗后治愈。39例术后病理诊断均为肾囊肿。术后随访5～36个月，平均22个月，复查超声均未见明显囊肿复发。结论经皮囊内入路肾囊肿电切去顶术安全可靠，具有手术时间短、创伤小、患者恢复快、住院时间短等优点。

Objective To compare the short term clinical efficacy of percutaneous resection and laparoseopie deroofing of renal cysts. Methods From October 2013 to June 2016, the data from 39 cases with renal cysts were followed for approximately 22 months （ranging 5 - 36 months ）. Patients were randomized into two groups. In the resectoscopic group（ 17 pts） , the mean age of those patients was 57 years （ranging 34 -81 years）. The mean size of these cysts was 6.4cm （ranging 5.4 - 8.2 cm）. The mean preoperative creatinine was 66.5μmol/L （ranging 38.1 - 108.8 μmol/L） . The mean preoperative sodium was 141.41.μmol/L（ ranging 135.6 - 145. 1 μmoL/L）. The mean preoperative potassium was 4.0 μmol/L （ranging 3.4 -4.7 μmol/L）. In the latter laparoseope （22pts） , the mean age of these patients was 60 years （ranging 46 - 73 years）. The preoperative creatinine was 74 mean size of these cysts was 6. 8cm （ranging 4.3 -8.9cm）. The mean 8μmol/L （ranging 48.6 - 141.9 μmol/L）. The mean preoperative sodium was 141.5 μmol/L （ranging 135.0 - 146.1 μmol/L）. The mean preoperative potassium was 4.0 μmoL/L （ranging 3. 1 - 4. 8 μmol/L）. The operative time, blood loss, days of drainage, hospital stay and complications were compared with the two groups. Results All of the 39 cases were accepted the procedure successfully without open conversion . Compared the resectoseopic group with Laparoscopie, the mean operative time was 29.7 min （ ranging 15 - 50 min） and 63.0min （ ranging 20 - 100 min ） , mean blood loss was 36.6ml（ ranging 10 - 80 ml） and 60.4ml（ ranging 10 - 200 ml） ,days of drainage was 2.3 days and 3.1 days ,hospital stay was 3.7 days and 5.1 days ,the mean postoperative ereatinine was 67.4 μmol/L（ ranging 43.8 -95.5 p, mol/L） and 68.9p.moL/L（ ranging 46.5 - 157.6 μ mol/L）, the mean postoperative sodium was 141.2μmol/L（ ranging 136.0 - 147.2 μmol/L） and 141.6 μmol/L（ ranging 136.0 - 147.2 μmol/L）, the mean postoperative potassium was 3.8μmol/L （ranging 3.2 -4.3 μmol/L） and 3.8μmol/L （ranging 3.3 -4. 3 μmol/L ）. The overall postoperative pathology was renal cysts. All cases were followed for approximately 19 months （ ranging 6 - 35 months ） and 22 months （ ranging 5 - 36 months ） in reseetoscopic and laparoscopie group respectively. No cysts recurrence was found by ultrasound. Conclusions Compared with laparoseopie deroofing, use of resectoscopic technology significantly enhances the possibility of achieving better intraoperative results in all patients with renal cysts. Pereutaneous resection of simple renal cysts is safe and feasible.