腹腔镜多囊肾囊肿去顶减压术联合输尿管软镜囊肿切开内引流术治疗多囊肾的初步研究
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摘要
目的研究腹腔镜多囊肾囊肿去顶减压术联合输尿管软镜囊肿切开内引流术治疗多囊肾的有效性。方法将本单位自2016年6月至2017年6月收治的常染色体显性遗传性多囊肾患者32例,随机分为A、B两组,A组16例,采用腹腔镜多囊肾囊肿去顶减压术,B组16例,在腹腔镜多囊肾囊肿去顶减压术后,再行输尿管软镜囊肿切开内引流术,两组手术均由同一医师进行手术。术后3个月、9个月及15个月定期随访,评估临床症状改善情况及术侧肾小球滤过率(glomerular filtration rate,GFR)改善情况和肾脏体积变化和大囊肿数量变化情况。结果两组患者术后9、15个月术侧GFR均较术前有明显提高(P<0.01),且B组较A组提高更为显著(P<0.05);术后3个月术侧肾脏体积均较术前有明显减小(P<0.01),且B组较A组减小更为显著(P<0.05);对于直径>4cm囊肿去除率B组明显优于A组(P<0.05)。结论腹腔镜多囊肾囊肿去顶减压术联合输尿管软镜囊肿切开内引流术治疗常染色体显性遗传性多囊肾病方法可靠,在传统去顶减压术去除肾脏表面及浅部囊肿的基础上,联合输尿管软镜囊肿切开内引流术可以去除腹腔镜手术难以清除的肾脏深部囊肿,内外结合,可更有效地去除肾脏囊肿,减轻囊肿对肾脏本身的压迫,从而尽可能地保护和恢复残余肾组织的功能。
Objective To explore the efficacy of laparoscopic decompression of cysts combined with endo-decortication of cyst by flexible ureterscope with Holium laser for the treatment of polycystic kidney disease.Methods 32 patients with autosomal dominant polycystic kidney disease were treated from June 2016 to June2017. They were randomly divided into group A and group B. 16 cases underwent laparoscopic decompression of cysts were named as group A,and 16 cases underwent laparoscopic decompression of cysts combined with endo-decortication of cyst by flexible ureterscope with holium laser were named as group B. Patients were followed up regularly in 3 rd,9 th and 15 th months postoperatively. The clinical symptoms,glomerular filtration rate( GFR),the change of kidney volume and the number of large cysts were recorded and compared statistically.Results The GFR of kidney in both groups in 9 th and 15 th months postoperatively were significantly improved( P < 0. 01) and the improvement in group B was more obviously than that of group A( P < 0. 05). The volume of kidney in both groups decreased significantly in 3 rd month after the operations( P < 0. 01),and the decrease in group B was more obviously than that of group A( P < 0. 05). The clearance rate of cysts larger than 4 cm in group B was significantly higher than that of group A( P < 0. 05). Conclusions It is an effective method for the treatment of autosomal dominant polycystic kidney disease by laparoscopic decompression of cysts combined with endo-decortication of cyst by flexible ureterscope with Holium laser. On the basis of laparoscopic decompression of cysts,endo-decortication of cyst by flexible ureterscope with Holium laser can treat those deep renal cysts which are difficult to remove by laparoscopic surgery.
Objective To explore the efficacy of laparoscopic decompression of cysts combined with endo-decortication of cyst by flexible ureterscope with Holium laser for the treatment of polycystic kidney disease.Methods 32 patients with autosomal dominant polycystic kidney disease were treated from June 2016 to June2017. They were randomly divided into group A and group B. 16 cases underwent laparoscopic decompression of cysts were named as group A,and 16 cases underwent laparoscopic decompression of cysts combined with endo-decortication of cyst by flexible ureterscope with holium laser were named as group B. Patients were followed up regularly in 3 rd,9 th and 15 th months postoperatively. The clinical symptoms,glomerular filtration rate( GFR),the change of kidney volume and the number of large cysts were recorded and compared statistically.Results The GFR of kidney in both groups in 9 th and 15 th months postoperatively were significantly improved( P < 0. 01) and the improvement in group B was more obviously than that of group A( P < 0. 05). The volume of kidney in both groups decreased significantly in 3 rd month after the operations( P < 0. 01),and the decrease in group B was more obviously than that of group A( P < 0. 05). The clearance rate of cysts larger than 4 cm in group B was significantly higher than that of group A( P < 0. 05). Conclusions It is an effective method for the treatment of autosomal dominant polycystic kidney disease by laparoscopic decompression of cysts combined with endo-decortication of cyst by flexible ureterscope with Holium laser. On the basis of laparoscopic decompression of cysts,endo-decortication of cyst by flexible ureterscope with Holium laser can treat those deep renal cysts which are difficult to remove by laparoscopic surgery.
引文
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[2]李斌,张沂南,金讯波,等.腹腔镜囊肿去顶减压术联合肾脏被膜剥脱术治疗常染色体显性遗传性多囊肾病的安全性及有效性评估[J].泌尿外科杂志(电子版),2011,3(2):4-6.
[3]熊晖,夏亭,蒋绍博,等.肾脏体积对常染色体显性遗传性多囊肾患者手术时机选择的影响[J].山东大学学报(医学版),2011,49(8):96-99.
[4]俞蔚文,张大宏,何翔,等.输尿管软镜下钬激光切开内引流术治疗肾盂旁囊肿的临床研究[J].中华泌尿外科杂志,2013,34(7):489-492.
[5]杨炜青,李逊,何永忠,等.输尿管软镜与微创经皮肾镜治疗多囊肾合并肾结石的疗效比较[J].中华腔镜泌尿外科杂志(电子版),2016,10(3):5-8.
[6]金讯波,张智宇.常染色体显性遗传多囊肾病发病机制的研究现状[J].泌尿外科杂志(电子版),2010,2(3):1-4.
[7]汤兵,梅长林,张玲,等.多囊肾病患者肾脏体积与临床表现关系的研究[J].诊断学理论与实践,2003,2(4):290-292.
[8]尉春晓,夏庆华.肾脏体积指标在监测成人型多囊肾病病情进展中的应用[J].泌尿外科杂志(电子版),2009,1(1):43-47.
[9]Ordon M,Urbach D,Mamdani M,et al.The surgical management of kidney stone disease:a population based time series analysis[J].J Urol,2014,192(5):1450-1456.
[10]Zhang J,Zhang J,Xing N.Polycystic kidney disease with renal calculi treated by percutaneous nephrolithotomy:a report of 11 cases[J].Urol Int,2014,92(4):427-432.
[2]李斌,张沂南,金讯波,等.腹腔镜囊肿去顶减压术联合肾脏被膜剥脱术治疗常染色体显性遗传性多囊肾病的安全性及有效性评估[J].泌尿外科杂志(电子版),2011,3(2):4-6.
[3]熊晖,夏亭,蒋绍博,等.肾脏体积对常染色体显性遗传性多囊肾患者手术时机选择的影响[J].山东大学学报(医学版),2011,49(8):96-99.
[4]俞蔚文,张大宏,何翔,等.输尿管软镜下钬激光切开内引流术治疗肾盂旁囊肿的临床研究[J].中华泌尿外科杂志,2013,34(7):489-492.
[5]杨炜青,李逊,何永忠,等.输尿管软镜与微创经皮肾镜治疗多囊肾合并肾结石的疗效比较[J].中华腔镜泌尿外科杂志(电子版),2016,10(3):5-8.
[6]金讯波,张智宇.常染色体显性遗传多囊肾病发病机制的研究现状[J].泌尿外科杂志(电子版),2010,2(3):1-4.
[7]汤兵,梅长林,张玲,等.多囊肾病患者肾脏体积与临床表现关系的研究[J].诊断学理论与实践,2003,2(4):290-292.
[8]尉春晓,夏庆华.肾脏体积指标在监测成人型多囊肾病病情进展中的应用[J].泌尿外科杂志(电子版),2009,1(1):43-47.
[9]Ordon M,Urbach D,Mamdani M,et al.The surgical management of kidney stone disease:a population based time series analysis[J].J Urol,2014,192(5):1450-1456.
[10]Zhang J,Zhang J,Xing N.Polycystic kidney disease with renal calculi treated by percutaneous nephrolithotomy:a report of 11 cases[J].Urol Int,2014,92(4):427-432.