后腹腔镜治疗复杂性肾囊肿14例报告  

Transretroperitoneal Laparoscopy for Complicated Renal Cysts:Report of 14 Cases

作　　者：瞿连喜[1] 顾建军[2] 黎力平[1] 龚旻[2] 胡巍[2] 

机构地区：[1]复旦大学附属华山医院泌尿外科,上海200040 [2]复旦大学附属华山医院南汇分院泌尿外科,上海201300

出　　处：《中国微创外科杂志》2012年第2期155-156,159,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨后腹腔镜治疗复杂性肾囊肿的疗效。方法 2006年1月～2010年12月后腹腔镜治疗复杂性肾囊肿14例,常规于腋后线第12肋缘下、腋中线髂嵴上、腋前线肋缘下做穿刺点,建立工作通道。根据术前影像学资料,寻找并游离出囊肿,电刀切开囊壁,吸净囊内液体并观察其形状,扩大囊壁口,检查囊腔内病变,距肾实质边缘约0.5 cm处切除囊壁,止血,生理盐水冲洗创面并置负压引流管。囊壁常规送病理检查。结果 13例手术成功,1例肾上极旁囊肿与膈肌粘连明显,术中损伤膈肌致气胸,中转开放手术。手术时间50～80 min,平均65 min;出血量60～180 ml,平均75 ml。术后24～48 h下床活动。术后2～4 d拔除引流管和导尿管。住院3～10 d,平均6 d。14例随访6～12个月,平均9.5月,症状缓解,无复发。结论后腹腔镜治疗复杂性肾囊肿疗效满意,但对于术前诊断不明,特别是有恶变倾向的肾囊肿,仍以开放手术为宜。Objective To explore the efficacy of transretroperitoneal laparoscopy for complicated renal cyst. Methods From January 2006 to December 2010, we retrospectively analyzed 14 cases of the complex renal cysts which were clinically diagnosed by KUB ＋ IVP, B-ultrasonography, CT or/and MRI. To establish operational channels, we made punctures at the posterior axillary line under the costal margin, middle axillary line above the crista iliaca, and anterior axillary line under the costal margin. Based on the preoperative imaging, we identified and separated the cyst, and then cut the cyst and sucked the liquid out. To inspect the lesions within the cyst, we enlarged the incision on the surface of the cyst, and then cut the cyst at 0.5 cm away from the renal parenchyma. Results The procedure was completed successfully in 13 cases, another patient, who had severe adhesion between the cyst and the diaphragm, was converted to an open surgery because of pneumothorax caused by injury to the diaphragm. The mean operation time in our patients was 65 min （50 -80） , and mean blood loss was 75 ml （60 - 180）. The patients resumed off-bed activities in 24 to 48 hours after the operation, and drainage tube and urinary catheter were removed in 2 to 4 days. The mean hospital stay was 6 days （3 10）. The patients achieved a follow-up for 6 to 12 months with a mean of 9.5 months, during which, all the patients were improved without recurrence. Conclusion Transretroperitoneal laparoscopy is effective for complicated renal cysts, however for the cases without preoperative diagnosis or suspicious of malignancy, open surgery is suggested.

关 键 词：肾囊肿 后腹腔镜 

分 类 号：R699[医药卫生—泌尿科学]