不同路径腹腔镜手术治疗单纯性肾囊肿的临床分析

Clinical Analysis of Different Path Laparoscopic Surgery for Simple Renal Cyst

目的探讨腹腔镜下经腹腔和经后腹腔行肾囊肿去顶术的临床疗效。方法选取该院2015年7月—2017年7月收治的肾囊肿患者50例为研究对象,根据手术路径的不同分为对照组和观察组,对照组为经腹腔路径肾囊肿去顶术,共25例患者。观察组为经后腹腔路径肾囊肿去顶术,共25例患者。对两组患者手术情况进行密切观察,分析比较手术时间、术中出血量、肠道功能恢复时间以及住院时间情况。结果所有手术均成功,无中转开放手术。两组病例手术时间、术中出血量、术后肠道功能恢复时间及住院时间指标比较,差异无统计学意义(P>0.05)。但当囊肿位于腹侧或背侧时采用不同的手术路径,手术时间差异有统计学意义(P<0.05)。当囊肿位于腹侧时,经腹腔途径手术时间较短,(经腹腔途径时间(68.33±8.66) min,经腹膜后途径时间(77.50±6.55)min]。差异有统计学意义(P<0.05)。当囊肿位于背侧时,经腹膜后途径手术时间明显较短,(经腹膜后途径时间(58.00±9.78)min,经腹腔途径时间(95.00±14.14)min],差异有统计学意义(P<0.001)。结论腹腔镜下行肾囊肿去顶术是治疗肾囊肿的安全、有效的方法。但囊肿位于肾脏背侧时选择经后腹腔途径更有优势,囊肿位于肾脏腹侧时经腹腔途径手术时间稍占优势。

Objective To evaluate the clinical efficacy of laparoscopic surgery for the removal of renal cysts through the abdominal cavity and posterior abdominal cavity. Methods A total of 50 patients with renal cysts admitted to the hospital from July 2015 to July 2017 were enrolled. The patients were divided into the control group and the observation group according to the different surgical routes.The control group was the peritoneal path renal cystectomy of 25 patients. The observation group was a retroperitoneal cystic renal cystectomy with a total of 25 patients. The operation of the two groups of patients was closely observed, and the operation time, intra-operative blood loss, intestinal function recovery time and hospitalization time were analyzed and compared. Results All operations were successful and there was no open surgery. There were no significant differences in the operation time, intraoperative blood loss,postoperative intestinal function recovery time and hospitalization time between the two groups（P〈0.05）. However, when the cyst is located on the ventral or dorsal side, different surgical paths are used, and the operation time is significantly different（P〈0.05）. When the cyst was located in the ventral side, the operation time was shorter through the abdominal cavity, [（68.33 ±8.66） min via the abdominal route and（77.50±6.55）min via the retroperitoneal route], the difference was no statistically significant（P〈0.05） When the cyst was located on the dorsal side, the operation time was significantly shorter after the retroperitoneal approach,（58.00 ±9.78）min after the retroperitoneal route,（95.00 ± 14.14）min via the abdominal route）, the difference was statistically significant Conclusion Laparoscopic renal cystectomy is a safe and effective method for the treatment of renal cysts. However, when the cyst is located on the dorsal side of the kidney, it is more advantageous to choose the posterior abdominal cavity. When the cyst is located in the ventral side of the kidney, the operation time through the abdominal cavity is slightly dominant.