后腹腔镜手术治疗肾盂旁囊肿的临床体会

目的:探讨后腹腔镜技术治疗肾盂旁囊肿的临床应用价值。方法:回顾分析2011年12月至2013年6月为25例肾盂旁囊肿患者行后腹腔镜肾囊肿去顶减压术的临床资料。均全身麻醉,建立后腹腔操作空间,沿输尿管上段寻及肾门,充分暴露肾盂旁囊肿,尽量切除囊肿壁,壁缘电灼,囊腔内塞入带蒂脂肪组织。结果:23例手术顺利完成,1例因分离时损伤肾静脉分支、1例因囊肿位置无法暴露中转开放手术。手术时间44~130 min,平均(65±26)min;术中出血量10~120 ml,平均(40±18)ml,无尿漏等并发症发生。术后随访至今,均无复发。结论:肾盂旁囊肿是肾囊肿的特殊类型,解剖结构复杂,手术操作难度较大,后腹腔镜技术可清晰地解剖肾门组织,充分暴露肾盂旁囊肿,是安全、微创、有效的治疗手段。

Clinical experience of retroperitoneal laparoscopic surgery for parapelvic cyst

Objective：To discuss the clinical value of retroperitoneal laparoscopic surgery for parapelvic cyst. Methods：The clinical data of 25 patients with parapelvie cyst of kidney undergoing retroperitoneal laparoseopic renal cyst unroofing were retrospectivey analyzed. They all underwent general anesthesia, the retroperitoneal space was established, the renal hilum was found along the upper ureter, the parapelvic cyst was fully exposed, the cyst wall was removed as much as possible, the edge of the wall was cauterized by dec- trotome, and the adipose tissue with pediele was filled in the cystic cavity. Results：There were 23 cases completed the procedure suc- cessfully. At the same time, there was one case of conversion to laparotomy because of damaging the renal vein branch during dissecting, and another one because of failure in exposure of the cyst. The operation time was 44-130 min and average （65 ± 26 ） min,intraopera- tive bleeding was 10-120 ml with the average of （40 ±18 ） ml. There were no postoperative complications such as urinary leakage. There was no recurrence during the follow-up to today. Conclusions ： Parapelvic cyst is a special type of renal cyst, which has complex anatom- ical structure and difficulty in operation. Retroperitoneal laparoseopy can have a clear anatomy of the renal hilum, and better exposure of the cyst, which is a safe, minimally invasive and effective treatment method.