两种后腹腔镜肾囊肿去顶术式治疗单纯性肾囊肿的对比研究

目的 比较传统后腹腔镜和单孔后腹腔镜肾囊肿去顶术两种术式治疗单纯性肾囊肿的优缺点.方法 回顾性分析采用传统后腹腔镜术式或者单孔后腹腔镜术式行肾囊肿去顶术治疗单纯性肾囊肿的临床资料.结果 2种术式治疗单纯性肾囊肿均未见术中并发症,术后复查均未见复发;两种术式在术中出血量、术后禁食时间、留置引流管的时间、术后住院时间方面,均无统计学差异(P＞0.05);在手术时间、术后下床活动时间、手术当天疼痛评分、术后并发症方面,均有统计学差异(P＜0.05).结论 在现有条件下,在治疗单纯性肾囊肿这一疾病,单孔后腹腔镜术式并不比传统后腹腔镜术式具有更明显的优势.     

后腹腔镜与开放性肾囊肿去顶术疗效比较

目的比较后腹腔镜与开放性肾囊肿去顶术的疗效,并探讨后腹腔镜肾囊肿去顶术处理要点。方法回顾性分析22例(后腹腔镜组)经后腹腔镜肾囊肿去顶术和41例(开放手术组)开放性肾囊肿去顶术患者的临床资料,比较2组手术时间、术中出血量和术后并发症、住院天数等指标。结果 2组手术均获得成功,后腹腔镜组手术时间、术中出血量、并发症发生率、术后住院时间均显著少于开放手术组(P0.05)。结论经后腹腔镜肾囊肿去顶术具有创伤小,患者恢复快、疼痛轻的优点,疗效明显优于开放手术。     

改良的后腹腔镜肾囊肿去顶术

目的 评估改良的后腹腔镜肾囊肿去顶术(RLRC)的临床应用价值.方法 15例为在减压前完整游离囊肿壁后减压的传统后腹腔镜肾囊肿去顶,12例为术中先行囊肿减压的改良去顶术,两相比较手术时间和出血量.结果 用改良的手术方法可以明显缩短手术时间,但出血量相比较无明显差异.结论 改良后的后腹腔镜肾囊肿去顶术使操作更简单、便捷,并同样安全有效.     

经后腹腔腹腔镜与开放性肾囊肿去顶术疗效比较

目的：比较经后腹腔腹腔镜与开放性肾囊肿去顶术的疗效，并探讨经后腹腔腹腔镜肾囊肿去顶术处理要点。方法：回顾性分析9例经后腹腔腹腔镜肾囊肿去顶术和21例开放性肾囊肿去顶术患者的临床资料，比较两组手术时间、术中失血量和术后住院天数等指标。结果：两组手术时间比较，差异无显著性意义（P＞0.05)，但经后腹腔腹腔镜手术组术中失血量及术后住院时间均显著少于开放性手术组（P＜0.01)。结论：经后腹腔腹腔镜肾囊肿去顶术具有创伤小，患者康复快、疼痛轻的优点，治疗单纯性肾囊肿的疗效明显优于开放性手术。     

后腹腔镜去顶术治疗单纯性肾囊肿临床分析

目的探讨单纯性肾囊肿经后腹腔镜肾去顶术的治疗效果及术后并发症发生情况。方法将90例符合手术指证的单纯性肾囊肿患者随机分为2组,每组45例。观察组实施后腹腔镜肾囊肿去顶术,对照组给予传统开腹手术。记录并分析2组治疗效果和预后情况。结果 2组治疗成功率均为100.00%,2组手术时间差异无统计学意义(P0.05);观察组术中出血量、术后引流管留置时间均显著少于对照组(P0.05),术后并发症发生率低于对照组,差异有统计学意义(P0.05)。结论对单纯性肾囊肿患者给予后腹腔镜囊肿去顶术,可显著提高疗效,有利于保障患者生活质量并使其尽快恢复健康。     

非气腹单孔后腹腔镜技术在肾囊肿去顶术中的应用

目的观察非气腹单孔后腹腔镜技术用于肾囊肿去顶术的临床效果。方法以60例单纯性肾囊肿患者为研究对象,按随机数字表方式将所有研究对象分为3组(研究组、对照组1和对照组2),每组各20例患者。研究组行非气腹单孔后腹腔镜肾囊肿去顶术,对照组1行传统后腹腔镜肾囊肿去顶术,对照组2行气腹单孔后腹腔镜肾囊肿去顶术。记录患者术中及术后康复情况。随访术后1年内并发症及肾囊肿复发情况,调查患者治疗满意度。结果各组患者腹腔镜手术均成功完成,而各组手术时间、拔管时间、住院时间、术后12小时疼痛评分和医疗费用差异均具有统计学意义(P0.05);研究组和对照组2术后并发症总体发生率(0.00%和0.00%)均显著低于对照组1水平(20.00%)(P0.05);各组患者手术治疗总体满意度水平差异具有统计学意义(P0.05),且研究组患者手术治疗总体满意度水平显著高于对照组1水平(P0.05)。结论非气腹单孔后腹腔镜技术用于肾囊肿去顶术,缩短患者术后康复周期,减轻术后痛苦,降低医疗成本,增加患者治疗满意度,具有一定的临床价值。     

自制单孔多通道装置在泌尿外科单孔后腹腔镜手术中的应用(附167例报告)

目的探讨自制单孔多通道装置在泌尿外科单孔后腹腔镜手术中的应用。方法回顾分析了从2011年6月至2014年5月笔者进行单孔后腹腔镜单纯肾切除术57例、单孔后腹腔镜肾癌根治术35例、单孔后腹腔镜肾上腺切除术36例、单孔后腹腔镜肾囊肿去顶术39例,共167例患者的临床资料。均采用1个切口保护套和1个无粉外科手套组成一个单孔多通道操作装置,使用常规腹腔镜器械进行单孔后腹腔镜手术,术后手术伤口常规予皮内缝合。结果 167例患者均成功进行单孔后腹腔镜手术,无改行常规后腹腔镜手术或开放手术。单孔后腹腔镜单纯肾切除术手术时间(90.0±38.2)分钟,单孔后腹腔镜肾癌根治术手术时间(120.0±33.7)分钟,单孔后腹腔镜肾上腺切除术手术时间(45.0±16.3)分钟,单孔后腹腔镜肾囊肿去顶术手术时间(35.0±15.6)分钟。术中出血量20~200ml,术后无需要输血患者,无重大手术并发症。所有患者均对手术伤口愈合后残留的微小瘢痕感到满意。结论应用自制单孔多通道装置进行泌尿外科单孔后腹腔镜手术安全可行、费用低,减少手术创伤。联合伤口皮内缝合,达到了患者的美观要求,应用前景广阔,可作为有手术伤口美观要求的患者,特别是女性患者行相关手术的首选治疗方法。     

后腹腔镜肾囊肿去顶术与开放性手术的比较

目的　比较后腹腔镜肾囊肿去顶术与开放手术的优越性。方法　采用后腹腔镜行肾囊肿去顶 36 例,并回顾性分析比较31例开放性肾囊肿去顶术。结果　腹腔镜手术用时20~75 min,平均45 min,术后恢复快。对比开放手术,腹腔镜手术的手术时间、术后并发症及术后住院时间均明显减少。结论　后腹腔镜肾囊肿去顶术治疗单纯性肾囊肿的疗效明显优于传统开放性手术,值得推广。     

单纯性肾囊肿不同治疗方法的对比研究

目的:评价单纯性肾囊肿行腹腔镜肾囊肿去顶术和经皮肾穿刺硬化术及开放肾囊肿去顶术的治疗效果。方法:回顾性分析85例单纯性肾囊肿患者的临床资料,男53例,女32例。年龄22~72岁,平均43岁。囊肿直径4.8~13.2cm,平均6.8cm。85例患者中,30例行腹腔镜去顶术治疗,30例开放性手术治疗,25例行经皮肾穿刺硬化术,对比分析三组患者手术时间、术中出血量、术后住院时间、术后放置引流管时间及复发率的差异,总结三种治疗方法的特点。结果:85例患者均顺利完成手术,术中术后无明显并发症。腹腔镜组和开放组囊肿去顶术后,囊肿复发率分别3.3%和0,明显小于经皮肾穿刺硬化术组的24%(P0.05);腹腔镜组和穿刺硬化术组术中出血量及术后引流时间均少于开放手术组(P0.05)。手术时间三组病例差异无统计学意义。结论:三种方法均有良好的效果,各有优缺点,其中腹腔镜肾囊肿去顶术具有手术时间短、出血量少以及复发率低等综合优势,值得推广,最终术式选择应根据囊肿特征及术者对患者的综合评估等多方面因素来考虑。     

腹腔镜与开放性肾囊肿去顶术的比较

目的 :比较开放性与腹腔镜肾囊肿去顶术的疗效和优点。方法 :采用腹腔镜经腹腔途径对 4 3例肾囊肿患者进行肾囊肿去顶术。并与 2 4例开放性肾囊肿去顶术患者进行比较。结果 :腹腔镜手术时间、术后住院时间均显著少于开放性手术 (P <0 0 1)。术后随访 3～ 12个月 ,未见复发。结论 :经腹腔途径腹腔镜肾囊肿去顶术治疗肾囊肿 ,疗效好 ,患者创伤小 ,术后康复快 ,明显优于开放性手术。     

腹膜后腹腔镜肾囊肿去顶术65例报告

目的:总结腹膜后腹腔镜肾囊肿去顶术的手术经验。方法:回顾分析2004年8月至2011年6月为65例患者行腹膜后腹腔镜肾囊肿去顶术的临床资料。其中男44例,女21例;28～77岁,平均53岁。结果:65例均顺利完成腹膜后腹腔镜手术,无一例中转开放。64例行肾囊肿去顶术,1例改行腹腔镜肾部分切除术。手术时间30～120 min,平均42 min。患者均未输血。术中、术后无明显并发症发生。65例患者均获随访,随访3～60个月,行B超或CT检查,均无囊肿或肿瘤复发。结论:腹膜后腹腔镜肾囊肿去顶术治疗单纯性肾囊肿安全、有效,值得推广应用。     

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。     

直接闭合式经腹膜后腹腔镜肾囊肿去顶术治疗肾囊肿

目的 探讨直接闭合式经腹膜后腹腔镜肾囊肿去顶术治疗效果. 方法 1996年12月～2003年9月,我院采用直接闭合式方法经腹膜后腹腔镜肾囊肿去顶术治疗肾囊11例.腰部髂嵴上2 cm腋中线交界处做小切口1～2 cm,深度至皮下组织,10 mm trocar直接穿刺进入后腹腔,自制注水气囊扩张腹膜后间隙,充分暴露肾囊肿,距离肾实质边缘0.5～1.0 cm处电刀切除囊壁. 结果 10例手术获得成功,手术时间30～100 min,平均77.5 min.术中出血量20～60 ml,平均30.9 ml.1例因暴露囊肿困难中转开放性手术.1例腹膜损伤.术后住院6～9 d,平均7.4 d.7例随访7～26个月,平均15.2月,B超检查肾囊肿无复发. 结论 直接闭合式经腹膜后腹腔镜肾囊肿去顶术创伤小、恢复快、疗效可靠.     

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.     

腹腔镜下肝肾囊肿开窗去顶术的临床应用

目的:探讨腹腔镜治疗肝肾囊肿的方法和效果。方法: 1994至2004年于腹腔镜下为68例肝肾囊肿患者行开窗去顶术,其中肝囊肿56例,肾囊肿12例,并注入无水酒精灌洗残留粘膜。结果: 68例手术全部成功,无中转开腹。手术时间30~70min,随访时间6个月~10年, 1例复发。结论:腹腔镜治疗肝肾囊肿安全可行,在严格掌握适应证的条件下值得推广应用。     

腹腔镜手术治疗肾囊肿23例疗效观察

目的 :探讨腹腔镜手术治疗单纯性肾囊肿的方法及疗效。方法 :通过经腹腔和经腹膜后两种途径 ,采用腹腔镜技术对 2 3例单纯性肾囊肿患者行囊肿去顶术 ,并与 9例行开放性肾囊肿去顶术的患者进行比较。结果 :经腹膜后途径手术的手术时间显著长于开放手术 (P <0 .0 5 ) ,经腹腔途径手术的手术时间与开放手术无显著性差异 (P >0 .0 5 ) ,腹腔镜手术患者的术中失血量及术后住院时间均显著少于开放手术 (P <0 .0 1)。结论 :腹腔镜手术是治疗单纯性肾囊肿创伤小、效果好的有效方法     

Conventional laparoscopic adrenalectomy versus laparoscopic adrenalectomy through mono port

A standard procedure for single-port laparoscopic adrenal surgery has not been established. We retrospectively investigated intraoperative and postoperative outcomes after laparoscopic adrenalectomy through mono port (LAMP) and conventional laparoscopic adrenalectomy to assess the feasibility of LAMP. Between March 2008 and December 2009, 22 patients underwent adrenalectomy at the Department of Surgery, Kangbuk Samsung Hospital. Twelve patients underwent conventional laparoscopic adrenalectomy and 10 patients underwent LAMP. The same surgeon performed all the surgeries. The 2 procedures were compared in terms of tumor size, operating time, time to resumption of a soft diet, length of hospital day, and postoperative complications. The 2 groups were similar in terms of tumor size (30.08 vs. 32.50 mm, P=0.796), mean operating time (112.9 vs. 127 min, P=0.316), time to resumption of a soft diet (1.25 vs. 1.30 d, P=0.805), and length of hospital day (4.08 vs. 4.50 d, P=0.447). Despite 1 patient in the LAMP group experiencing ipsilateral pleural effusion as a postoperative complication, this parameter was similar for the 2 groups (P=0.195). Perioperative mortality, blood transfusion, and conversion to open surgery did not occur. Perioperative outcomes for LAMP were similar to those for conventional laparoscopic adrenalectomy. LAMP appears to be a feasible option for adrenalectomy.     

Laparoscopic decortication of symptomatic renal cysts: Experience from a referral center in Iran

Objective:   To present our experience with laparoscopic management of symptomatic simple renal cysts.
Methods:   From April 2004 to November 2006, 21 patients (10 men; 11 women) underwent laparoscopic decortication for simple renal cysts at our department and were included in the analysis. All procedures were carried out by one surgeon using a transperitoneal approach. Patients underwent radiological follow-up with computerized tomography and/or ultrasonography. Procedural success was defined as no recurrence of the cyst and complete pain relief. Symptomatic success was defined as a significant pain decrease.
Results:   All 21 procedures were completed laparoscopically, without major complications or conversion to open surgery. Estimated mean blood loss during surgery was about 50 mL. Patients were hospitalized for a mean of 1.9 ± 1.1 (range: 1–5) days. Age of the patients and size and location of the cysts, had no relationship with the duration of operation as well as the length of hospital stay ( P  > 0.05). Patients who experienced complete pain relief had significantly larger cyst sizes compared with patients with a partial pain decrease (7.3 ± 1.1 vs 9.1 ± 2.0, respectively; P  = 0.023, F  = 0.606). All patients had negative cytological and pathological findings for malignancy or any other abnormalities. At 16.6 months of mean follow up, none of the patients reported symptomatic and/or radiologic failure.
Conclusions:   Laparoscopic transperitoneal decortication represents an effective and safe treatment option in the management of symptomatic renal cysts.     

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.     

Cholelithiasis and renal cysts: simultaneous laparoscopic treatment

Laparoscopic surgery has been increasingly used in different fields of surgery. This report concerns the authors' experience with combined laparoscopic cholecystectomy and symptomatic renal cyst decortication. The mean diameter of the cysts was 11.2 cm. and involved the left and right kidney in 3 and 1 patient, respectively. All cysts were peripheral. Surgery was performed using 4 trocars in 3 cases and 5 trocars in the other. The mean operative time was 110 minutes and mean blood loss 40 cc. Postoperative pain was minimal. The mean duration of postoperative ileus was 2.2 days. No significant complications were observed. The mean postoperative hospital stay was 3.5 days. At follow-up examinations all patients were pain-free. Recurrence of the cyst was observed in only one case. Combined laparoscopic cholecystectomy and renal cyst decortication is technically feasible in selected cases and does not seem to significantly affect the perioperative course of cholecystectomy.