目的:比較和評(píng)價(jià)后腹腔鏡去頂減壓術(shù)、開放性去頂減壓術(shù)和穿刺硬化術(shù)的治療單純性腎囊腫的效果。方法:138例單純性腎囊腫者中采用后腹腔鏡去頂減壓術(shù)48例,開放性去頂術(shù)56例,穿刺硬化術(shù)34例。對(duì)3種術(shù)式的臨床療效、術(shù)后恢復(fù)及費(fèi)用等進(jìn)行對(duì)比研究。結(jié)果:3組患者在年齡、性別、側(cè)別、隨訪時(shí)間及囊腫大小上差異無統(tǒng)計(jì)學(xué)意義。腹腔鏡組癥狀消失者72.9%,癥狀好轉(zhuǎn)者22.9%,無復(fù)發(fā);開放手術(shù)組癥狀消失者69.6%,癥狀好轉(zhuǎn)者26.8%,無復(fù)發(fā);穿刺硬化組癥狀消失者35.3%,癥狀好轉(zhuǎn)者58.8%,復(fù)發(fā)29.4%。腹腔鏡組術(shù)后均未注射止痛劑,平均發(fā)熱21d,住院35d,傷口疼痛麻木持續(xù)1.5個(gè)月;開放手術(shù)組術(shù)后39.3%(22/56)注射止痛劑,平均發(fā)熱4.4d,住院5.4d,傷口疼痛麻木持續(xù)5.6個(gè)月;穿刺硬化組術(shù)后無注射止痛劑,平均發(fā)熱0.2d,住院0.8d,傷口疼痛麻木持續(xù)0.5月。術(shù)后并發(fā)癥發(fā)生率腹腔鏡組為6.3%(3/48),主要為腎周血腫和感染;開放手術(shù)組為8.9%(5/56),主要為傷口感染、應(yīng)激性潰瘍等;穿刺硬化組為2.9%(1/34),主要為腎周血腫。腹腔鏡組和開放手術(shù)組費(fèi)用顯著高于穿刺硬化手術(shù)組(P lt;0.05)。結(jié)論:腹腔鏡腎囊腫去頂術(shù)療效確切、復(fù)發(fā)率低、并發(fā)癥少、費(fèi)用高;開放性腎囊腫去頂術(shù)療效確切、復(fù)發(fā)率低、并發(fā)癥多、費(fèi)用高;穿刺硬化術(shù)療效確切、復(fù)發(fā)率高、并發(fā)癥少、費(fèi)用低。在單純性腎囊腫的治療中,腹腔鏡手術(shù)已經(jīng)成為治療的金標(biāo)準(zhǔn),但根據(jù)患者的病情和經(jīng)濟(jì)社會(huì)情況可選擇開放手術(shù)和穿刺硬化手術(shù)治療。
引用本文： 唐鐵龍,鄧顯忠,龔志勇,姜果,鮮述彥,李建勇,曾德朗,崔曙. 單純性腎囊腫3種手術(shù)治療效果的比較. 華西醫(yī)學(xué), 2009, 24(5): 1227-1229. doi: 復(fù)制
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- 1. 王國(guó)民,孫立安,徐俊華,等.閉合式經(jīng)后腹腔腹腔鏡腎囊腫去頂[J].中華外科雜志,1998,36:146148.
- 2. LAUCK S P, MCLACHLAN M S F. Aging and simple cysts of the kidney[J]. Br J Rad,1981,54:12.
- 3. RUBENSTEIN S C, HULBERT J C,PHARAND D, et al. Laparoscopic ablation of symptomatic renal cysts[J]. J Urol,1993,150:11031106.
- 4. HULBERT J C, SHEPARD T G, EVANS R F. Laparoscopic surgery for renal cystic disease[J]. J Urol,1992,147:443A..
- 5. MORGAN C, RADER D. Laparoscopic unroofing of a renal cyst[J]. J Urol,1992,148:18351836.
- 6. 那彥群,李雙利,郭應(yīng)祿.腹腔鏡切除腎囊腫[J].中華泌尿外科雜志,1994,5:342344.
- 7. DENIS E, NICOLAS F, BEN R N, et al. Laparoscopic surgical treatment of simple cysts of the kidney[J]. Prog Urol,1998,8:195200.