Preliminary experience of intracapsular unroofing of renal cysts with percutaneous nephroscope
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摘要: 目的：探讨一种肾囊肿囊内去顶手术的方法，评估该手术的安全性与近期并发症。方法：2017年1月~2019年7月南昌大学第一附属医院和鄱阳县人民医院收治背侧外生型单纯性肾囊肿16例患者，其中男7例，女9例，年龄21~57岁。所有患者行经皮肾镜肾囊肿囊内去顶手术：经皮穿刺扩张，建立进入肾囊肿的通道，退出囊肿，分离囊壁与肾周脂肪之间的间隙，回到囊肿内，沿囊壁与肾实质的交界处做标记点，沿标记点切开，完整取出囊壁，检查术野，置肾周引流管。观察患者记录手术经过、手术时间、出血量、引流管总的引流量、围手术期并发症、术后住院时间、围手术期血清电解质变化、冲洗液吸收情况、拔出引流管时间及预后。结果：16例患者均一次穿刺扩张成功，距肾实质3~5 mm切除囊壁。手术时间28~47 min，平均35 min。术中无明显出血，无周围脏器损伤病例，无冲洗液体大量吸收及水中毒发生。术后住院时间1~4 d，平均2.3 d。术后3个月复查B超及双肾CT平扫，结果显示肾囊肿完全消失9例，囊肿直径缩小为原直径的50%以上7例，有效率100%。结论：肾囊肿囊内去顶手术在实现与腹腔镜手术一样的完整切除囊壁的同时，仅需要最小程度的分离，而且明确的手术步骤，使手术过程流畅、可控、安全。Abstract: Objective: To introduce a method of intracapsular unroofing of renal cysts and evaluate the safety and short-term complications of the operation in this paper. Method: From January 2017 to July 2019, 16 patients with simple dorsal exogenous renal cyst were admitted to First Affiliated Hospital of Nanchang University and Poyang County People's Hospital, including 7 males and 9 females, aged 21-57 years old. All patients underwent percutaneous nephroscopic intracapsular unroofing as follows:percutaneous puncture dilation was performed to establish a channel to enter the renal cyst; then exit the cyst and separate the gap between the cyst wall and the perirenal fat; returning to the cyst, mark points were made along the junction of the cystic wall and renal parenchyma, cut open along the mark points, remove the cystic wall completely, check the operative field, and place the perirenal drainage tube. The operation course, operation time, blood loss, total drainage volume, perioperative complications, postoperative hospital stay, changes of serum electrolyte during perioperative period, absorption of flushing fluid, time of pulling out drainage tube and prognosis were observed and recorded. Result: All 16 patients underwent successful puncture and dilatation at one time, the cystic wall was excised 3-5 mm from the renal parenchyma. The operation time ranged from 28 to 47 min, with an average of 35 min. There was no obvious intraoperative bleeding, no cases of peripheral organ injury, no massive absorption of flushing fluid or water poisoning. The postoperative hospital stay was 1-4 days, with an average of 2.3 days. Three months after operation, ultrasonography and CT scan were performed. The results showed that the renal cyst disappeared completely in 9 cases, the cyst diameter was reduced to more than 50% of the original diameter in 7 cases, and the effective rate was 100%.Conclusion: The intracapsular removal of the renal cyst achieves the same complete removal of the cyst wall as laparoscopic surgery does with only minimal separation. Moreover, clear surgical procedures make the surgical process smooth, controllable and safe.
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Key words:
- percutaneous nephroscope /
- renal cyst /
- plasma column electrode /
- intracapsular unroofing
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