腹膜后腹腔镜肾囊肿去顶术8例报告

目的 :探讨腹膜后腹腔镜肾囊肿去顶术的适应证和术中处理要点。方法 :对 8例肾囊肿患者经腰部腹膜后入路行腹腔镜肾囊肿去顶术。结果 :7例手术成功 ,1例转为开放性手术。术后住院 2～ 4d,平均 2 .3d。结论 :腹膜后腹腔镜肾囊肿去顶术损伤小 ,出血少 ,术后住院时间短 ,康复快。早期开展本手术时 ,适应证的选择较为重要 ,必要时应及时中转术式。     

腹膜后腹腔镜手术治疗肾囊肿的手术疗效及并发症防治

目的:探讨腹膜后腹腔镜肾囊肿去顶术的临床疗效及并发症防治措施。方法:回顾分析2011年4月至2012年8月为15例患者行腹膜后腹腔镜肾囊肿去顶术的临床资料。结果:15例均顺利完成手术,无一例中转开放;手术时间30～65 min,平均(47.6±10.3)min;术中出血量10～70 ml,平均(46.6±14.4)ml;术后住院3～7 d,平均(3.5±1.1)d;1例多发囊肿患者术后引出暗红血液,量约150 ml,予以止血支持等对症治疗,出血量逐日减少,术后7 d拔管出院。随访1～12个月,无尿漏、复发。结论:腹膜后腹腔镜肾囊肿去顶术疗效确切、患者创伤小、康复快,是治疗肾囊肿的理想术式,掌握后腹膜腔的手术解剖及精细操作是防止并发症发生及手术成功的关键。     

腹膜后腹腔镜手术治疗35例肾囊肿

目的探讨腹膜后腹腔镜肾囊肿手术的方法及疗效. 方法 35例采用全麻,水囊扩张后腹膜腔,通过腰大肌、腹膜返折、膈肌脚等标志找到并暴露肾囊肿,超声刀距肾实质3～5 mm将囊壁切除去顶. 结果 35例肾囊肿顺利切除去顶,手术时间15～60 min,平均32 min.术中出血量5～60 ml,平均35 ml.术后住院3～6 d.34例病理报告为良性病变,1例怀疑囊性腺癌.35例随访1～22个月,1例术后1个月B超复查仍有直径1.5 cm囊肿,余未见囊肿复发.可疑腺癌者随访1年,胸片及肝肾B超无肿瘤生长及转移灶. 结论腹膜后腹腔镜肾囊肿去顶术是治疗肾囊肿安全、有效的方法.     

经腹膜后腹腔镜囊肿去顶术治疗肾囊肿35例临床体会

目的 探讨经腹膜后腹腔镜囊肿去顶术治疗单纯肾囊肿的疗效,并讨论手术适应症和手术要点。 方法 对我科在2005年10月~2010年9月采用经腹膜后腹腔镜囊肿去顶术治疗肾囊肿35例的临床资料进行回顾性分析。 结果 32例手术成功,术中出血量50~250ml（平均80ml）,平均住院时间为7d。在手术开展早期有3例中转开放手术,其中1例膈肌损伤,2例腹膜损伤,技术熟练后无并发症发生。所有患者随访6个月,仅有1例复发。术后恢复快。 结论 经腹膜后腹腔镜囊肿去顶术具有安全、疗效好、创伤小、恢复快的优点,宜作为单纯性肾囊肿外科治疗的首选术式。     

腹膜后腹腔镜肾囊肿去顶术20例报告

目的 探讨在肾囊肿去顶术中腹腔镜的应用.方法 对20例肾囊肿患者经腹膜后入路行腹腔镜肾囊肿去顶术.结果 18例手术成功,2例转为开放手术,术后住院3-5d,平均3.5d.结论 后腹腔镜肾囊肿去顶术具有安全、损伤小、出血少、术后恢复快等特点,是一种治疗肾囊肿疾病的安全有效的手术方式.     

腹膜后腹腔镜肾囊肿去顶术20例报告

目的 探讨在肾囊肿去顶术中腹腔镜的应用.方法 对20例肾囊肿患者经腹膜后入路行腹腔镜肾囊肿去顶术.结果 18例手术成功,2例转为开放手术,术后住院3-5d,平均3.5d.结论 后腹腔镜肾囊肿去顶术具有安全、损伤小、出血少、术后恢复快等特点,是一种治疗肾囊肿疾病的安全有效的手术方式.     

腹膜后腹腔镜肾囊肿去顶术20例报告

目的 探讨在肾囊肿去顶术中腹腔镜的应用.方法 对20例肾囊肿患者经腹膜后入路行腹腔镜肾囊肿去顶术.结果 18例手术成功,2例转为开放手术,术后住院3-5d,平均3.5d.结论 后腹腔镜肾囊肿去顶术具有安全、损伤小、出血少、术后恢复快等特点,是一种治疗肾囊肿疾病的安全有效的手术方式.     

单孔法后腹腔镜下肾囊肿去顶术

目的探讨单孔法后腹腔镜在肾囊肿去顶术中的应用价值。方法采用单孔法后腹腔镜下完成肾囊肿去顶术8例。男5例,女3例。年龄36～67岁,平均42岁。左侧5例,右侧3例。囊肿大小4．6 cm×4．3 cm～7．6 cm×10．2 cm,平均5．6 cm×8．5 cm。结果8例手术均成功,手术时间平均52（45～95）min,术中出血量平均25（0～100）ml,平均1．5（1～4）d拔除引流管,平均1．5 （1～3）d下床活动,术后住院时间平均4．5（3～5）d,8例术后随访1～6个月,经B超和CT或MRI等复查,肾囊肿无复发。结论单孔法后腹腔镜下肾囊肿去顶术具有微创、创口出血少、康复快等优点,具有较高的实用性,安全有效,是治疗肾囊肿的理想术式。     

腹腔镜肾囊肿去顶术治疗肾盂旁囊肿的体会

目的:总结腹腔镜肾囊肿去顶术治疗肾盂旁囊肿的临床疗效。方法:回顾分析为21例肾盂旁囊肿患者经腹腔入路行腹腔镜肾囊肿去顶术的临床资料。结果:21例手术均获成功,手术时间35～85 min,平均52 min;术中出血量5～40 ml,平均16 ml;无肾蒂、肾盂损伤等并发症发生,平均住院7 d。术后随访3年,1例于术后8个月复发,再次手术;其余患者随访至今均无复发。结论:腹腔镜肾囊肿去顶术治疗肾盂旁囊肿具有患者创伤小、出血少、疗效确切等优点,可作为肾盂旁囊肿的常规治疗方法。     

腹腔镜技术治疗复发性肾囊肿的探讨

目的：观察应用腹腔镜技术再次治疗腹腔镜肾囊肿去顶术后复发性囊肿的可行性。方法：总结5例腹腔镜技术治疗腹腔镜。肾囊肿去顶术后囊肿复发的临床资料,其中3例经腹腔途径,2例经腹膜后途径。结果：5例患者手术均获得成功。手术时间50～100min,平均75min。出血60～180ml,无并发症发生,术后住院4～9天,术后随访6～14个月,未再复发。结论：对于复发性肾囊肿仍可采取腹腔镜技术进行手术处理。     

小切口肾镜下治疗单纯性肾囊肿(附26例报告)

目的探讨肾镜下治疗单纯性肾囊肿的临床价值。方法第12肋尖下做长2～4cm小切口，肾镜下对单纯性肾囊肿26例进行去顶减压。结果手术时间20～80min，平均30min。术后住院3～6d，平均4d。术中均未输血，未出现严重并发症。26例随访3～12个月，平均8个月，均无复发。结论小切口肾镜下肾囊肿去顶减压术可行，手术操作简便、创伤小、术后恢复快，值得临床推广。     

后腹腔镜一期手术治疗34例双侧肾囊肿的疗效观察

目的探讨后腹腔镜一期手术治疗双侧单纯性肾囊肿的临床价值。方法对34例后腹腔镜一期行双侧肾囊肿去顶减压患者临床资料进行回顾分析。其中男1例,女13例,年龄17～65岁(34±0.53),囊肿直径5.32±1.31cm,左侧囊肿43个,右侧48个。结果经后腹膜入路34例患者双侧肾囊肿顺利去顶,平均每侧手术时间37.28±0.45min,平均每侧术中出血量7.18±0.53ml,2例随访3～6个月无复发,术中出现单侧腹膜损伤,未伤及腹腔脏器。平均住院天数7.47±0.32d,平均术后住院天数4.10±0.27d。结论后腹腔镜一期行双侧肾囊肿去顶术是一种安全、可行的治疗方式。     

Retroperitoneoscopic decortication of symptomatic renal cysts

PURPOSE: To determine the safety and efficacy of retroperitoneoscopic decortication of symptomatic renal cysts. PATIENTS AND METHODS: A total of 24 patients with symptomatic 6- to 14-cm (mean 10.9-cm) simple renal cysts, right sided in 13 and left sided in 11, underwent retroperitoneoscopic decortication for pain relief at our center between January 1997 and December 2002. The diagnosis was based on an ultrasonogram and contrast-enhanced CT. Symptom severity, assessed using a visual analog pain scale, averaged 7.2/10 (range 6.5-9). The mean duration of symptoms was 4 months. Operative and follow-up data were collected prospectively and analyzed for symptomatic and objective evidence of improvement. RESULTS: The mean operating time was 95 minutes, and no major complications were observed. The average hospital stay was 2.9 days (range 2-7 days). At a mean follow-up of 2.8 years (range 1.5-5 years), pain relief was reported by 22 patients (change of pain score from 7.2 to 1.4). One patient had worsening of pain at 6 weeks postoperatively. Asymptomatic recurrence of the cyst was seen in two patients on the follow-up ultrasound scans. CONCLUSIONS: Retroperitoneoscopic renal-cyst decortication is a safe, minimally invasive, and efficacious procedure for the treatment of painful renal cysts, with a durable response.     

后腹腔镜手术治疗巨大肾上腺囊肿(附9例报告)

目的:探讨后腹腔镜手术治疗巨大肾上腺囊肿的优点及应用价值。方法:回顾分析2007年3月至2011年11月9例巨大肾上腺囊肿患者的临床资料,其中男3例,女6例,左侧5例,右侧4例,囊肿直径均≥6 cm。采用腹膜后途径,根据术中情况行腹腔镜肾上腺部分切除术、肾上腺全切除术(包括因囊肿过大、压迫难以鉴别肾上腺的患者)、单纯肾上腺囊肿去顶减压术。结果:9例手术均获成功,其中肾上腺部分切除术4例,肾上腺全切除术3例,单纯肾上腺囊肿去顶减压术2例。手术时间平均(73.36±20.88)min,术中出血量平均(76.6±34.7)ml,平均住院(5.6±1.8)d。病理诊断为肾上腺囊肿,其中内皮性囊肿5例,假性囊肿4例。围手术期无并发症发生。随访3～37个月,平均17个月,无一例复发。结论:后腹腔镜手术治疗巨大肾上腺囊肿疗效确切,患者创伤小、出血少、康复快、住院时间短,对于腹腔镜手术经验丰富的术者,可作为首选。     

Retroperitoneoscopic management of infected cysts in adult polycystic kidney disease.

Conservative measures are the mainstay of therapy in adult polycystic kidney disease (APKD). Pain, infection and obstructive uropathy are the major indications for intervention. Chronic pain has been treated with narcotic analgesics, needle aspiration of dominant cysts, and open renal cyst decortication. Laparoscopic cyst decortication, by either transperitoneal or retroperitoneal access, is a new emerging option with similar efficacy to open surgery and less morbidity. Cyst infection in these patients responds poorly to commonly used antibiotics. Patients with refractory cyst infection may even require nephrectomy. Herein, we present 2 cases with APKD that were treated by retroperitoneoscopic decortication for painful and infected cysts. Both patients showed prompt and sustained improvement in symptoms, with minimal morbidity and short convalescence. This approach has not hitherto been described for infected cysts in APKD. The retroperitoneoscopic route should be preferred in the presence of infected cysts so as to prevent intraperitoneal contamination.     

腹腔镜下肾盂旁囊肿去顶减压术

目的：评价腹腔镜技术治疗肾盂旁囊肿的有效性和安全性。方法：采用腹膜后途径、经腹腔途径及单孔腹腔镜技术行肾盂旁囊肿去顶减压术21例。结果：21例患者手术全部成功。手术时间35～150min,平均55min;术中出血量5～100ml,平均30ml。术后2～5天（平均3．2天）拔除引流管。术后住院时间4～9天,平均6．5天。1例术中肾盂修补者术后漏尿1天,引流量为200ml,其余围术期无并发症。术后随访2～36个月,无复发。结论：腹腔镜技术治疗肾盂旁囊肿具有创伤小、出血少、恢复快等优点,疗效满意,是肾盂旁囊肿治疗的理想方式。     

Retroperitoneal decortication of simple renal cysts vs decortication with wadding using perirenal fat tissue: results of a prospective randomized trial

OBJECTIVES

To evaluate, in a pilot prospective randomized trial, the safety, effectiveness and radiological recurrence of retroperitoneal renal cyst decortication compared with retroperitoneal decortication with wadding using perirenal pedicled fat tissue.

PATIENTS AND METHODS

From March 2004 to December 2007, 40 patients with simple renal cysts were enrolled and randomized; 22 (group A) had a simple retroperitoneal decortication (SRD) and 18 (group B) a decortication with wadding of the cyst using perirenal fat tissue (RDCW). The following variables were recorded: age, gender, side, size on ultrasonography/computed tomography (CT), location, operative duration, blood loss, complications, pathology, presence or absence of flank pain, hypertension, urinary tract compression or urinary infection. The primary endpoint of this trial was to evaluate and compare the efficacy of both treatments. Secondary endpoints were safety and pain, hypertension and the resolution of urinary tract obstruction.

RESULTS

In all, 40 cysts were treated; there were no bilateral cysts. The mean (sd ) size on CT was 11.9 (1.84) cm in group A and 12.8 (1.25) cm in group B (P = 0.1). All the procedures were completed laparoscopically and no conversion was necessary. There were no intraoperative complications. The mean (range) hospital stay was 3.4 (3–6) days. There was no statistically significant difference between the groups for all variables assessed. There was a radiological recurrence in three patients (14%) in group A, but none in group B (all successful).

CONCLUSION

To be completely successful, with maximum safety and to prevent recurrences in the treatment of renal cysts, RCDW is recommended when a retroperitoneal approach is chosen, especially if the cyst is located anteriorly. When symptom relief is considered, RCDW duplicates the results obtained with SRD.     

Retroperitoneal laparoscopic decortication of simple renal cysts using the bipolar PlasmaKinetic scissors

OBJECTIVES: To analyse the efficacy, safety and feasibility of retroperitoneal laparoscopic decortication of simple renal cysts using bipolar PlasmaKinetic scissors. METHODS: Records of 19 patients who underwent laparoscopic decortication of simple renal cysts, performed with bipolar PlasmaKinetic scissors without additional fulguration of the base or the margin of resection, were retrospectively reviewed. Long-term symptomatic and radiological outcomes were assessed. RESULTS: One single cyst was treated in fourteen (73.7%) cases, two cysts in three (15.8%) cases, three cysts in one (5.2%) case and multiple cysts in one case with autosomal dominant polycystic kidney disease. They were peripherally located in thirteen, peripelvic in three, and parenchymal in two cases. An average of 3.1 trochars were used for each procedure. The mean operating time was 82.5 +/- 16.7 min (range, 50-135). Neither open conversion nor blood transfusion was necessary. A total of six minor complications were encountered. Mean hospital stay 2.3 +/- 0.9 days (range, 1-4). After a mean follow up of 14.3 +/- 5.9 months (range, 3-24), symptomatic success was achieved in 89.5%, and radiological success was accomplished in 88.2%. An asymptomatic cyst recurrence was observed in one (5.9%) case, and one (5.9%) case with residual pain had new cyst formation at another site of the kidney. CONCLUSIONS: Retroperitoneal laparoscopic cyst decortication using bipolar PlasmaKinetic scissors is a feasible and efficient method, eliminating further fulguration of the base and the margins of the cysts. Operating times are shorter than previously published series and highly satisfactory long-term success rates are achieved.     

Percutaneous nephrostomic decortication: a microinvasive surgery for posterior renal cyst

To assess the safety, feasibility, and efficacy of a modified process we developed in order to perform decortication surgeries for simple renal cysts through a percutaneous approach, 18 patients with simple renal cysts larger than 5 cm were treated with our new technique, from November 2016 to January 2019. All of the cysts were evaluated with ultrasonography and contrast-enhanced computed tomography. The Surgical procedure: as the standard mini-Percutaneous Nephrostomy procedure, a puncture was made directly into the cyst through the cyst roof under ultrasound guidance. After the inner cyst wall examination, the sheath was then retracted to just outside the cyst roof. The sheath together with the scope was used to detach the roof from the perirenal fat, after which the cyst roof was resected using a laser. A drain tube was left in the retroperitoneal space for 1–2 days. Subsequently, all patients were discharged 1 to 2 days post-surgery. Skin incision was less than 1 cm. No major complication was observed. The follow-up time ranges from 14 to 37 months. One case had an incompletely resected cyst with the cyst volume being decreased by more than 60%. This patient didn’t receive any additional treatments during his follow-up. For all the other patients, the cysts had completely disappeared and no relapse had occurred. In conclusion, in the selected patients with a simple posterior renal cyst, our new technique is a safe and an effective option. It is also considered the least invasive decortication surgery for posterior renal cyst.