经腹腹腔镜联合生物蛋白胶治疗单纯性腹侧肾囊肿的临床分析

目的 探讨经腹腹腔镜联合生物蛋白胶治疗单纯性腹侧肾囊肿的临床效果.方法 回顾性分析采用经腹腹腔镜联合生物蛋白胶治疗单纯性腹侧肾囊肿患者19例临床资料.结果 19例患者均在经腹腹腔镜下顺利完成,术中成功向残留囊腔灌注生物蛋白胶,手术时间44～120min,平均56min,术后住院时间3～7天,平均4.2天,术中术后无大出血、酸中毒等并发症.结论 经腹腹腔镜联合生物蛋白胶是治疗单纯性腹侧肾囊肿的一种有效方法,安全、疗效确切.     

声学造影在肾囊肿硬化治疗中的应用

目的：回顾分析囊肿内声学造影在肾囊肿硬化治疗中的应用价值,提高肾囊肿硬化治疗的安全性。方法：对33例接受肾囊肿硬化治疗的患者,于术前先行肾囊肿腔内声学造影：确认为单纯性肾囊肿,遂行肾囊肿硬化治疗;疑为肾盂源性肾囊肿,则放弃硬化治疗。结果：33例患者中,确认为单纯性肾囊肿并接受硬化治疗31例,有效率为87.1%;疑似肾盂源性囊肿2例,转行外科手术治疗。结论：囊肿内声学造影对鉴别单纯性与肾盂源性肾囊肿有较高的应用价值,可提高肾囊肿硬化治疗的安全性。     

无水乙醇换洗联合医用生物蛋白胶治疗巨大肾囊肿临床观察

目的 探讨无水乙醇换洗联合医用蛋白胶注射治疗巨大肾囊肿的临床效果.方法 巨大肾囊肿39例均行B超引导下经皮、经肾囊肿穿刺置管术.根据囊肿直径分为3组:A组26例( 10 ～15cm),B组9例(15～20cm),C组4例(＞20cm).每次注入无水乙醇1～2次,注入量为囊肿体积的1/4～1/3,当囊肿引流量＜10ml/d并经B超检查囊肿直径3～6cm,注入医用生物蛋白胶5～10ml后拔除置管.结果 所有患者均一次性穿刺成功,成功率100％,术后均放置导管引流.A组囊肿全部闭合时间为30d,B组为70d,C组随访12个月仍未闭合,但均明显缩小,直径＜6cm.本组治愈率89.7％,有效率100％.结论 B超引导下经皮、经肾囊肿中穿刺置管无水乙醇换洗联合医用蛋白胶注射治疗巨大肾囊肿方法简单、微创、完全性高、疗效确切.     

生物蛋白胶在肾囊肿穿刺注射中的应用

肾囊肿常见，50岁以上发病率达50％，囊肿较小者多在健康体检或其他疾病检查时偶然发现。较大者（≥4cm）可压迫肾实质或引起出血、感染等，常需治疗。肾囊肿穿刺注射硬化剂治疗较为常用。胜利油田临盘医院在B超定位引导下经皮穿刺抽液注射生物蛋白胶治疗单纯性肾囊肿96例，取得良好效果。     

颈静脉留置针穿刺治疗单纯性肾囊肿的体会

目的探讨颈静脉留置针穿刺治疗单纯性肾囊肿的疗效. 方法回顾分析61例单纯性肾囊肿在超声波定位下使用颈静脉留置针行囊肿穿刺并联合无水乙醇注射治疗的临床资料. 结果一次性治愈52例,复发9例,再次穿刺治愈6例,3例反复复发后改行囊肿去顶术治愈.除3例有一过性淡血尿外,余无并发症. 结论用颈静脉留置针行单纯性肾囊肿穿刺治疗具有微创、安全、有效和经济等优点.     

单纯性肾囊肿分型及其意义的研究

目的 提出一种对单纯性肾囊肿的分型方法,并探讨该分型方法的临床意义.方法 根据囊肿的大小、位置及是否突出于肾表面,分为3型:Ⅰ型囊肿直径≤3 cm;Ⅱ型囊肿直径>3 cm且位于肾实质内,没有突出于肾表面;Ⅲ型囊肿直径大于3 cm且突出于肾表面.对搜集到的135例单纯性肾囊肿患者进行分型,对不同类型患者的临床资料进行分析.结果 Ⅰ型肾囊肿患者中44例未予特殊处理,6例行穿刺硬化治疗术后3例复发;Ⅱ型肾囊肿患者中30例行腹腔镜肾囊肿去顶减压术,1例复发;6例行肾囊肿穿刺硬化治疗并放置引流管持续引流,1例复发;Ⅲ型肾囊肿患者中43例行腹腔镜肾囊肿去顶减压术,6例行肾囊肿穿刺硬化治疗,均未见复发.结论 通过分型便于临床描述,可以为临床医生对单纯性肾囊肿的处理提供一个有效地术前评估标准.Ⅰ型肾囊肿建议定期观察,Ⅱ型大者肾囊肿腹腔镜肾囊肿去项减压术应作为首选治疗方案,小者可以考虑行肾囊肿穿刺硬化并置管引流,Ⅲ型肾囊肿可以选择应用腹腔镜肾囊肿去项减压术或肾囊肿穿刺硬化治疗.     

单纯性肾囊肿的治疗(附121例分析)

目的总结单纯性肾囊肿的治疗经验。方法回顾性分析了121例单纯性肾囊肿患者的临床资料,其中69例行经皮囊肿穿刺抽液无水酒精注射法,33例行开放手术(其中22例行小切口肾囊肿去顶减压术),19例行腹腔镜肾囊肿去顶减压术。总结不同方法的治疗效果。结果各组均取得满意的治疗效果,并发症发生率低。穿刺组住院费用低,小切口手术组在治疗效果和住院费用上有优势。结论不同的治疗方法各有优缺点,根据患者的情况选择治疗方法能够取得满意的效果。     

经皮穿刺注入四环素后持续引流治疗单纯性肾囊肿(46例分析)

目的探讨单纯性肾囊肿穿刺注入四环素后持续引流的治疗效果。方法对46例单纯性肾囊肿患者在B超引导下行囊肿穿刺抽出囊液后注入四环素,留置导管,持续引流1周。结果拔管后,囊肿闭合消失率为100%,41例患者获得随防,随访1～4年,未复发者38例(92.6%)。结论采取穿刺注入四环素后持续引流治疗单纯性肾囊肿是一种有效手段。     

3种手术方法治疗肾囊肿的对比研究(附106例报告)

目的比较经皮肾囊肿穿刺硬化治疗、小切口肾囊肿去顶术、经腹腔镜肾囊肿去顶术3种手术方法的优缺点,探讨肾囊肿手术方法的选择。方法回顾分析2001年1月~2004年11月3种方法治疗106例肾囊肿的临床资料,比较3种方法的手术时间、出血量、治疗费用、治愈率等。结果穿刺组治疗费用(3 261.8±779.2)元最少,治愈率(78.6%,22/28)最低,复发率(21.4%,6/28)最高;小切口组手术时间(44.1±5.7)m in最短;腹腔镜组治疗费用(9 050.9±1 116.2)元最高;以上指标3组间差异有显著性(P<0.05)。小切口组和腹腔镜组治愈率均为100%,无复发病例,出血量和治愈率等指标差异无显著性(P>0.05)。结论3种方法各有独特优势,应根据具体情况选择最佳手术方法。直径<7 cm的单纯性薄壁肾囊肿,若患者一般情况或经济条件较差可选择穿刺硬化治疗;肾下极或肾中部背侧单纯性薄壁囊肿可首选小切口肾囊肿去顶术;其他肾囊肿特别是双肾多发囊肿、巨大囊肿及不能排除恶性者应首选腹腔镜肾囊肿去顶术。     

C型臂X线机引导经椎板穿刺生物蛋白胶注射术和开放手术治疗症状性骶管囊肿的疗效比较

[目的]比较两种手术方法治疗症状性骶管囊肿的疗效。[方法]2003年6月～2011年4月,分别采用C型臂X线机引导下经椎板穿刺注射医用生物蛋白胶封闭囊肿术(蛋白胶注射组30例)及棘突切除、椎板开窗囊肿摘除术(囊肿摘除术组18例)治疗48例有临床症状的骶管囊肿患者,比较两组患者术前、术后腰骶部疼痛和功能改善情况。[结果]手术时间、术中出血量、住院时间、并发症,蛋白胶注射组均明显小于囊肿摘除术组(P<0.01)。蛋白胶注射组5例失访,囊肿摘除术组4例失访,总失访率18.8%。随访时间7～96个月,平均18.4个月。两组患者末次随访时VAS和ODI评分与术前比较有显著差异(P<0.01),蛋白胶注射组、囊肿摘除术组间VAS评分改善率比较差异有统计学意义(P<0.05),ODI评分改善率比较差异有显著统计学意义(P<0.01)。蛋白胶注射组患者疼痛改善时间及功能改善时间均较囊肿摘除术组患者早。根据分级标准,蛋白胶注射组疼痛改善优良率为88%,囊肿摘除术组为71%;蛋白胶注射组功能改善优良率为88%,囊肿摘除术组为71%。[结论]C型臂X线机引导下注射生物蛋白胶治疗骶管囊肿是一种有效的治疗方法,可免除开放手术的创伤痛苦,具有微创操作、安全、经济等优点。     

Laparoscopic management of a giant hepatic cyst with fibrin glue fixation of the omentum

Approximately 4.5% to 7% of the population will have simple hepatic cysts, but only 5% of these will require treatment. Drainage options include interventional, laparoscopic, and open techniques ranging from simple aspiration to liver resection. We present a case where a giant hepatic cyst was treated laparoscopically and omentum was fixed in the defect using fibrin glue to prevent recurrence. A 69-year-old female patient presented with a recurrent simple hepatic cyst after percutaneous aspiration had failed. Her symptoms were related to the size of the cyst. Laparoscopic drainage was performed with cyst wall excision. Omentum was fixed in the defect using fibrin glue. She was discharged after 24 hours without complication. There are many ways to treat nonparasitic liver cysts. The laparoscopic approach limits morbidity with excellent results. The use of fibrin glue to secure omentum in the defect is a simple technique to limit recurrence.     

The diagnosis and treatment of cystic diseases of the kidneys by using transcutaneous puncture methods under ultrasonic monitoring

Presented in the paper are the methods of ultrasonic diagnosis and percutaneous paracentetic treatment of cystic kidneys under ultrasonic monitoring. Paracenteses were performed in 172 patients: 59 with polycystic and 113 with cystic kidneys. If the cysts located in the middle or lower segments of posterior, lateral or inferior drainage that was pushed through the guide into the cyst lumen. A thin-needle aspiration was used and the drainage avoided if the cyst located in the anterior part of middle or upper renal segments. Cystography and cystomanometry associated with the determination of the cyst tension index followed elimination of the aspirates for cyto- and bacteriological investigations. Paracentesis was accomplished under the ultrasonic monitoring of the position of a needle tip. The cavity of the cyst was sclerosed with 96% spirit in 84 patients; strong radiopaque agents were used in 8 and medicinal cyanacrylate glue in 13 patients. The drainage of the cysts with a long-term exposure to sclerosing agents (from 2 to 24 hrs) was employed in 32 patients. Postaspiration relapses were documented in all the patients with intrasinus cysts and cysts, whose major portion was surrounded by parenchyma. In the patients with other patterns of cyst location, the postaspiration relapses were noted in 94.4 per cent. A four-year follow-up of 13 patients who sustained the glue application registered 2 relapses which were successfully cured by a repeat application of the glue.(ABSTRACT TRUNCATED AT 250 WORDS)     

肾囊性疾病和肾盏憩室的腔镜下切开内引流术

目的：探讨经皮。肾镜及逆行软性输尿管肾镜下切开内引流术治疗。肾囊性疾病和肾盏憩室的安全性和可行性。方法：回顾性分析2010年1月～2013年2月对23例患者采用经皮肾镜及逆行软性输尿管肾镜下肾囊肿或肾盏憩室内切开引流术的临床资料。其中单纯肾囊肿5例,肾盂旁囊肿11例,肾盏憩室6例,多囊肾1例。囊肿、憩室直径平均4．7cm。手术方法采用全麻,顺行经皮。肾镜或逆行软性输尿管。肾镜下观察囊肿憩室的解剖位置及形态。直视下用钬激光将憩室口内切开扩大或凸起的菲薄囊壁切开一定范围开窗引流,使之与集合系相通。术后留置双J管引流。结果：23例患者均手术成功。手术时间36～75rain,平均48．9min。术后无大出血、严重感染、尿漏等并发症。术后随访3～24个月,11例囊肿消失,5例囊肿明显缩小,6例肾盏憩室消失,1例多囊肾囊肿（直径〉2cm者）数量明显减少。结论：经皮肾镜及逆行软性输尿管肾镜下内切开引流术治疗肾囊性疾病和肾盏憩室具有安全、有效,恢复快的特点,远期疗效有待进一步观察随访。     

经皮囊内入路电切去顶术治疗单纯性肾囊肿16例报告

目的:评估经皮囊内入路电切去顶术治疗单纯性肾囊肿的疗效,以探讨低侵袭性、彻底的肾囊肿治疗方式。方法:我院于2011年4月~2013年12月采用经皮肾穿刺囊肿去顶术治疗单纯性肾囊肿患者16例。患者平均年龄59(23~78)岁;囊肿位于左肾13例,右肾3例。囊肿直径平均8.2(5.2~12.8)cm。术中在超声定位下应用经皮肾穿刺技术配合双极电切镜切除游离于肾脏外侧的囊壁,术后留置引流管2d。结果:14例患者手术顺利完成,囊肿完全消失。意外发现1例肾细胞癌,二期行肾部分切除术;1例因出血中转开放手术。平均手术时间68(15~125)min。平均随访15(1~32)个月,未见复发。结论:单纯性肾囊肿可以用经皮肾穿刺去顶术安全解决。此技术优于腹腔镜肾囊肿去顶减压术,避免了多个trocar的安置及广泛的肾周剥离,降低了手术难度。     

Treatment of symptomatic simple renal cysts by percutaneous aspiration and ethanol sclerotherapy

OBJECTIVE: To report our experience with the use of 95% ethanol as sclerotherapy for symptomatic simple renal cysts. PATIENTS AND METHODS: Sixty patients with 64 symptomatic simple renal cysts were treated by ultrasonography (US)-guided percutaneous aspiration and injection of 95% ethanol (31 men and 29 women, mean age 46 years, SD 22). The main presentation was renal pain in 34 patients, renal mass in nine, hypertension in 11 and haematuria in six; 24 cysts were on the right, 32 on the left and four bilateral. Patients were evaluated after 1 month and then every 6 months by clinical assessment, US and intravenous urography. Success was defined as complete when there was total ablation of the cyst and partial when there was a recurrence of less than half the original cyst volume with the resolution of symptoms. Failure was defined as the recurrence of more than half of cyst volume and/or persistent symptoms. RESULTS: After aspiration and ethanol sclerotherapy, there was microscopic haematuria in two patients and low-grade fever (<38.3 degrees C) in two, but no major complications. During a mean (range) follow-up of 19 (14-40) months there was complete cyst ablation in 54 cysts and partial resolution in 10. Pain disappeared or was much improved in all patients. After cyst ablation hypertension was well controlled with no medication in all 11 hypertensive patients and haematuria disappeared in all six affected patients. CONCLUSIONS: Ethanol sclerotherapy for symptomatic simple renal cysts is simple, minimally invasive and highly effective. We recommend it as the first therapeutic option in these patients.     

Biochemical and pharmacodynamic studies of simple renal cyst fluids in relation to infection

Biochemical analysis of renal cyst fluid was performed in 53 patients with simple renal cysts including 2 infected cases. The composition of noninfected cyst fluid tended to parallel that of serum. Additionally, the penetration of amikacin into cyst fluid was studied in 2 infected and in 11 noninfected patients following a single 200-mg intramuscular injection of amikacin. Drug levels in the fluid were below detection limit in the noninfected and approximately half or less of the serum values in the infected patients. These data may explain one of the reasons why infection of simple renal cysts is highly resistant to antimicrobial chemotherapy. The value of treatment by percutaneous aspiration and drainage of infected cysts is emphasized.     

输尿管软镜结合可视穿刺内切开治疗肾盂旁囊肿二例报告

输尿管软镜内切开引流术是近年来治疗肾盂旁囊肿的新型手术方式,术中寻找囊肿最薄处行切开引流是手术的关键点和难点。本文报道2例患者,术中应用可视穿刺针辅助寻找囊肿最薄处,并行内切开引流术,手术经过顺利,术后2年复查,结果显示手术效果佳。     

Sonographically detected malignant transformation of a simple renal cyst

The clinical course is reported of a simple renal cyst which developed into a septated renal cyst, and finally to a cystic renal cell carcinoma. A 49-year-old man, who had been diagnosed as having a renal cyst, was found by repeated ultrasonography over 6 years to have solid components developing within the cyst. Radical nephrectomy was performed, and pathological examination confirmed cystic renal cell carcinoma (RCC). This case clearly shows a natural history of malignant transformation from a simple renal cyst, and emphasizes that careful follow-up of renal cysts, especially of complicated renal cysts, is mandatory for successful treatment of RCC.     

Management of urine leak after laparoscopic cyst decortication with retrograde endoscopic fibrin glue application and ureteral stent placement

Urine leakage is an uncommon complication after renal cyst decortication that typically resolves with adequate drainage. With prolonged large volume urine leakage from a perinephric drain, however, consideration for open surgical repair must be taken into account. We present the successful management of persistent urine leakage after laparoscopic cyst decortication with endoscopic retrograde fibrin glue injection and ureteral stent placement.