Singh Iqbal, Mehrotra Gopesh
Department of Surgery (Division of Urology), University College of Medical Sciences, University of Delhi and GTB Hospital, Delhi, India.
Urology. 2006 Sep;68(3):482-7; discussion 487-8. doi: 10.1016/j.urology.2006.03.080.
To evaluate the clinical efficacy and outcome of 99% ethanol as a sclerosing agent for managing chronic flank pain due to dominant cysts in selected patients with adult polycystic kidney disease. Traditionally, such patients have been treated with analgesics and surgical/laparoscopic deroofing. Cyst aspiration sclerotherapy is a minimally invasive therapeutic option for such patients, and limited published data exist on this subject. This formed the basis for the present study.
A pilot study was undertaken during a 1-year period to evaluate the clinical efficacy of ultrasound-guided cyst aspiration-ethanol injection sclerotherapy in 15 preselected patients with diagnosed adult polycystic kidney disease. All punctures were performed with strict aseptic precautions and local anesthesia on an outpatient basis. The patients were evaluated with serial scans, pain scores, and serum creatinine values.
A total of 48 dominant cysts were successfully treated in all 15 patients with regard to cyst aspiration and shrinkage. At the end of 1 year, the pain and dominant cysts had completely disappeared in 13 patients and had recurred in 2; repeat cyst aspiration and sclerotherapy was done in 3 patients. Nephrocutaneous fistula and urinary tract infection occurred in 1 patient each. The decrease in the pain score and the rise in the serum creatinine level were statistically significant at P <0.05 and P <0.001, respectively.
Alcohol cyst sclerotherapy is a minimally invasive, safe, and effective alternative to conventional surgical/laparoscopic deroofing for managing chronic flank pain due to adult polycystic kidney disease in selected patients. It should be considered as a safe and viable therapeutic option in patients in whom the primary symptom is chronic flank pain due to one or more dominant cysts.
评估99%乙醇作为硬化剂治疗成年多囊肾病特定患者因主要囊肿引起的慢性胁腹痛的临床疗效和结局。传统上，此类患者一直采用镇痛药以及手术/腹腔镜去顶术治疗。囊肿穿刺硬化疗法是此类患者的一种微创治疗选择，关于这一主题的已发表数据有限。这构成了本研究的基础。
在1年期间进行了一项前瞻性研究，以评估超声引导下囊肿穿刺乙醇注射硬化疗法对15例预先选定的已确诊成年多囊肾病患者的临床疗效。所有穿刺均在门诊严格无菌预防措施和局部麻醉下进行。通过系列扫描、疼痛评分和血清肌酐值对患者进行评估。
在所有15例患者中，总共48个主要囊肿在囊肿穿刺和缩小方面均得到成功治疗。在1年结束时，13例患者的疼痛和主要囊肿完全消失，2例复发；3例患者进行了重复囊肿穿刺和硬化疗法。各有1例患者发生肾皮肤瘘和尿路感染。疼痛评分的降低和血清肌酐水平的升高在统计学上具有显著意义，分别为P<0.05和P<0.001。
对于选定的成年多囊肾病患者，酒精囊肿硬化疗法是一种微创、安全且有效的替代传统手术/腹腔镜去顶术治疗慢性胁腹痛的方法。对于以一个或多个主要囊肿引起的慢性胁腹痛为主要症状的患者，应将其视为一种安全可行的治疗选择。
