Departments of Urology and Experimental Surgery, UNIVALI (University of Itajai Valley), and INCAU (Catarinense's Urological Institute), Itajai, Santa Catarina, Brazil.
J Endourol. 2010 Sep;24(9):1405-10. doi: 10.1089/end.2009.0467.
Renal cysts are the most common form of renal mass with a prevalence of 35% in people older than 50 years. Several techniques are used to manage symptomatics cysts, from sclerotherapy to open surgery. We present a safe and minimally invasive therapeutic alternative: Percutaneous endocystolysis (PE).
Between 1995 and 2008, 32 patients were treated for large symptomatic Bosniak type I and II renal cysts with the PE technique. Percutaneous access was obtained by direct puncture guided by fluoroscopy or ultrasonography, percutaneous dilation, and placement of a 28F Amplatz sheath; then a 26F resectoscope with a rollerball electrode was introduced into the interior of the cyst and the whole internal surface was inspected and cauterized. After cauterization, a 20F Foley catheter was placed inside the cyst. Patients were discharged the next day, and the catheter was removed in the outpatient facility after 7 to 10 postoperative days. The variables of age, cyst volume, operative time, and length of hospital stay were statistically analyzed using the Pearson linear correlation coefficient.
Clinical follow-up ranged from 4 to 162 months (mean 76 mos). Percutaneous access to the cyst was obtained by blind puncture in 7 (21.8%) patients, aided by fluoroscopy in 12 (37.5%) patients, and guided by ultrasonography in 13 (40.7%) patients. Clinical improvement was observed in all patients with a success rate of 100%. The length of hospital stay was 21.7 ± 8.5 hours (range 9-48 h). The operative time was 41.8 ± 19.7 minutes (range 12-94 min). There was a low complication rate associated with the transparenchymatous PE procedure.
PE is a safe, minimally invasive, and effective technique for the management of large symptomatic renal cysts and is associated with high success rates and low complication rates in long-term follow-up.
肾囊肿是最常见的肾肿块形式，50 岁以上人群的患病率为 35%。有几种技术可用于治疗有症状的囊肿，包括硬化疗法到开放手术。我们提出了一种安全且微创的治疗选择：经皮囊内切开术（PE）。
1995 年至 2008 年间，32 例大型有症状 Bosniak Ⅰ型和Ⅱ型肾囊肿患者采用 PE 技术进行治疗。经皮入路通过透视或超声引导下的直接穿刺、经皮扩张和放置 28F Amplatz 鞘管获得；然后将带有滚球电极的 26F 电切镜引入囊肿内部，检查和烧灼整个内部表面。烧灼后，将 20F Foley 导管放入囊肿内。患者次日出院，术后 7 至 10 天在门诊取出导管。使用 Pearson 线性相关系数对年龄、囊肿体积、手术时间和住院时间等变量进行统计学分析。
临床随访时间为 4 至 162 个月（平均 76 个月）。7 例（21.8%）患者通过盲目穿刺、12 例（37.5%）患者通过透视辅助和 13 例（40.7%）患者通过超声引导获得囊肿入路。所有患者均观察到临床改善，成功率为 100%。住院时间为 21.7±8.5 小时（9-48 小时）。手术时间为 41.8±19.7 分钟（12-94 分钟）。经皮肾实质切开术相关并发症发生率低。
PE 是一种安全、微创、有效的大型有症状肾囊肿治疗方法，在长期随访中具有较高的成功率和较低的并发症发生率。
