后腹腔镜下肾囊肿去顶减压术后囊肿复发的预防方法研究  

Prevention of recurrence of simple renal cyst after retroperitoneal laparoscopic decortication

作　　者：吴晨光 郭君其[1] 谭建明[1] Wu Chenguang;Guo Junqi;Tan Jianming.(Department of Urology, Fuzhou General Hospital of PIA , Fuzhou 350025, Chin)

机构地区：[1]福州解放军福州总医院泌尿外科,福建350025

出　　处：《国际泌尿系统杂志》2018年第3期395-398,共4页International Journal of Urology and Nephrology

基　　金：福建省自然科学基金项目（2012J01404）

摘　　要：目的 探讨降低后腹腔镜下肾囊肿去顶减压术后复发的有效方法.方法 回顾性分析2014年1月至2016年3月在本院收治的328例单纯性肾囊肿行后腹腔镜下肾囊肿去顶减压术患者的临床和随访资料,其中仅行去顶减压术105例（常规组）,在去顶减压术基础上术中追加了预防复发的干预方法223例包括无水乙醇硬化治疗60例（硬化治疗组）、肾周脂肪填塞囊78例（脂肪填塞组）、囊壁外翻钛夹固定85例（钛夹固定组）.对比各组手术时间、术中出血量、术后并发症、术后住院时间、术后复发情况.结果 随访12 -38个月,中位随访时间24.8个月,与常规组比较,尽管3种干预方法（硬化治疗组、脂肪填塞组和钛夹固定组）术后复发率均显著降低（5％、3.8％、4.7％与13.3％,F=8.319,P=0.040）,但是硬化治疗组手术时间延长[（40.7±12.6）min与（30.5±10.2） min,t=5.664,P〈0.001]、术后并发症增加（21.7％与6.7％,x2 =8.065,P =0.005）,而脂肪填塞组、钛夹固定组对手术时间、术中出血量、术后并发症发生率和术后住院时间指标均无统计学意义（P〉0.05）.结论 后腹腔镜下肾囊肿去顶减压术中联合肾周脂肪填塞或囊壁外翻钛夹固定是降低术后囊肿复发的安全有效方法,无水乙醇硬化治疗有增加手术时间和并发症之虞不宜选择.Objective To investigate the effective method of reducing the recurrence of renal cyst after retroperitoneal laparoscopic decortication.Methods The clinical and follow-up data of 328 cases of patients with simple renal cyst underwent retroperitoneal laparoscopic renal cyst decompression from January 2014 to March 2016 in our hospital were analyzed retrospectively.One hundred and five patients had a simple decortication （control group,n =105）.The remaining 223 patients had a decortication with different intervention method to prevent recurrence,including 60 cases with anhydrous ethanol sclerotherapy （sclerotherapy group,n =60）,78 cases with wadding of the cyst using perirenal fat tissue （fat wadding group,n =78） and 85 cases with evaginated and fixed the cyst wall by titanium clips （titanium clips fixed group,n =85）.The operation time,intraoperative blood loss,postoperative complications,postoperative hospital stay and recurrence rate after 1 year were compared.Results Compared with the control group,all the 3 intervention methods （sclerotherapy group,fat wadding group and titanium clips fixed） significantly decreased the 1 year recurrence rate （5%,3.8%,4.7% vs.13.3%,F=8.319,P=0.040）.However,the operation time [（40.7 ±12.6）min vs.（30.5 ± 10.2） min,t =5.664,P 〈 0.001] and postoperative complications rate （21.7% vs.6.7%,x2 =8.065,P =0.005） increased significantly in the sclerotherapy group.The operative time,intraoperative bleeding volume,postoperative complications and postoperative hospital stay in both of the fat wadding group and the titanium clips fixed group were all similar to the controlgroup （P 〉 0.05）.Conclusions Combined with wadding of the cyst using perirenal fat tissue or evaginated and fixed the cyst wall by titanium clips in the retroperitoneal laparoscopic decortication is a safe and effective method to reduce postoperative recurrence.The anhydrous ethanol sclerotherapy may be an inappropriate choice due to increased operation time and complications.

关 键 词：肾疾病 囊肿 腹腔镜 减压术 外科 

分 类 号：R699.2[医药卫生—泌尿科学]