经腹腔与腹膜后腹腔镜肾囊肿去顶减压术的疗效分析(附50例报告)

Curative effect analysis of laparoscopic transabdominal and retroperitoneal renal cyst fenestration:with a report of 50 cases

目的:对比分析经腹腔入路与腹膜后入路行腹腔镜肾囊肿去顶减压术的临床疗效,探讨肾囊肿行腹腔镜手术的入路选择。方法:回顾分析2015年1月至2019年12月为50例肾囊肿患者行腹腔镜肾囊肿去顶减压术的临床资料,其中经腹腔入路20例(腹腔组,2例合并胆囊结石,同期行胆囊切除术),腹膜后入路30例(腹膜后组,3例合并同侧输尿管结石,同期行输尿管切开取石术),对比两组手术时间、术中出血量、引流管留置时间、术后住院时间。结果:两组手术均获成功,无明显并发症发生。腹膜后组手术时间短于腹腔组(P<0.01),术中出血量少于腹腔组(P<0.05);两组拔管时间、术后住院时间差异无统计学意义(P>0.05)。结论:腹腔镜肾囊肿去顶减压术采用腹腔入路与腹膜后入路均是安全、有效的,腹膜后入路的手术时间更短、术中出血量更少,具体采用哪种入路取决于术者习惯与经验。

Objective:To compare the curative effect of laparoscopic renal cyst fenestration in transabdominal approach and retroperitoneal approach,and to explore the choice of laparoscopic surgical approaches for renal cysts.Methods:Clinical data of 50 patients who suffered from renal cyst and underwent laparoscopic renal cyst deroofing and decompression from Jan.2015 to Dec.2019 were analyzed retrospectively.There were 20 cases in transabdominal approach(2 cases with cholecystolithiasis,cholecystectomy was performed simultaneously),and 30 cases in retroperitoneal approach(3 cases were complicated with ipsilateral ureterolithiasis,and ureterolithotomy was performed simultaneously),the operation time,intraoperative blood loss,drainage tube indwelling time and postoperative hospital stay of the two approaches were compared.Results:Both approaches were performed successfully without obvious complications.The operation time in the retroperitoneal group was significantly shorter than that in the transabdominal group(P<0.01).The intraoperative blood loss in the retroperitoneal group was less than that in the transabdominal group(P<0.05).There was no significant difference in extubation time and postoperative hospital stay between the two groups(P>0.05).Conclusions:Both transabdominal approach and retroperitoneal approach of laparoscopic renal cyst fenestration are safe and effective.The retroperitoneal approach has shorter operation time and less intraoperative blood loss.Which approach can be used depends on the habits and experience of the surgeons.When there is a surgical disease near the kidney cyst that requires surgical treatment,it is more appropriate to use an approach that can simultaneously deal with the combined disease.