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目的总结肾脏囊性病变的治疗经验,探讨单纯性肾囊肿、多囊肾、肾盂旁囊肿及囊性肾癌的手术适应证和手术方式的选择。方法单纯性肾囊肿32例,其中行囊肿穿刺术15例,经腹腹腔镜肾囊肿去顶术12例,经腹膜后腹腔镜行肾囊肿去顶术5例。3例肾盂旁囊肿行腹膜后腹腔镜囊肿去顶术,5例多囊肾行经腹腹腔镜囊肿去顶减压术。2例囊性肾癌采用开放性肾癌根治术。结果所有病例手术均获成功。单纯性肾囊肿行囊肿穿刺术者随访2~25个月,4例复发,占26.7%;经腹腹腔镜肾囊肿去顶术者,随访1~25个月,1例复发,占8.3%;经腹膜后腹腔镜行肾囊肿去顶术者,随访2~20个月无复发。3例肾盂旁囊肿行腹膜后腹腔镜去顶术,随访3~6个月无复发。5例多囊肾行经腹腹腔镜囊肿去顶减压术者,术后肾功能改善2例,血压下降3例,血尿消失1例。2例行开放性肾癌根治术者,术后随访2个月和6个月,无肿瘤复发。结论囊肿穿刺简单易行,目前仍是治疗单纯性肾囊肿的一线治疗手段,但存在较高的复发率。腹腔镜技术对大部分肾脏囊性病变的处理都是合适的,根据囊肿位置、数目和医生技术水平可选择经腹腔或经腹膜后途径。腹腔镜肾囊肿去顶术具有创伤小、恢复快的优点。囊性肾癌术前诊断尤为重要,易被误诊,开放性肾癌根治术仍是治疗囊性肾癌的主要手段。
Objective To summarize the treatment experience of renal cystic lesions and to explore the surgical indications and surgical methods of simple renal cysts, polycystic kidney disease, renal plexus cyst and cystic renal cell carcinoma. Methods 32 cases of simple renal cysts, including cyst puncture in 15 cases, laparoscopic renal cyst debridement in 12 cases, retroperitoneal laparoscopic renal cyst in 5 cases. 3 cases of retroperitoneal cyst retroperitoneal laparoscopic cyst debridement, 5 cases of polycystic kidney via abdominal laparoscopic cyst decompression surgery. 2 cases of cystic renal cell carcinoma with open radical nephrectomy. Results All cases were successful. Patients with simple renal cyst cyst puncture were followed up for 2 ~ 25 months, 4 cases of recurrence, accounting for 26.7%; transabdominal laparoscopic renal cyst debridement were followed up for 1 ~ 25 months, 1 case of recurrence, accounting for 8.3%; Retroperitoneal laparoscopic renal cyst debridement were followed up for 2 to 20 months without recurrence. 3 cases of retroperitoneal cyst retroperitoneal laparoscopic retrospective surgery, 3 to 6 months follow-up without recurrence. 5 cases of polycystic kidney via laparoscopic cyst decompression surgery, renal function improved in 2 cases, 3 cases of decreased blood pressure, hematuria disappeared in 1 case. 2 cases of open radical nephrectomy, were followed up for 2 months and 6 months, no tumor recurrence. Conclusion Cyst puncture is simple and easy, and is still the first-line treatment for simple renal cysts, but there is a high recurrence rate. Laparoscopic treatment of most of the cystic lesions of the kidney are appropriate, depending on the location of the cyst, the number of doctors and technical level can choose the transabdominal or retroperitoneal approach. Laparoscopic renal cyst demyocardial surgery has the advantages of small trauma, rapid recovery. Preoperative diagnosis of cystic renal cell carcinoma is particularly important, easily misdiagnosed, open radical nephrectomy is still the main means of treatment of cystic renal cell carcinoma.