Lai Shicong, Xu Xin, Diao Tongxiang, Jiao Binbin, Jiang Zhaoqiang, Zhang Guan
Peking University China-Japan Friendship School of Clinical Medicine Department of Urology, China-Japan Friendship Hospital, Beijing Department of Urology, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China.
Medicine (Baltimore). 2017 Oct;96(41):e8259. doi: 10.1097/MD.0000000000008259.
Treatment options for simple renal cyst (SRC) include open surgery, laparoscopy with decortication, or percutaneous aspiration with or without sclerotherapy. Though laparoscopic unroofing achieves better results than percutaneous sclerotherapy, the reported recurrence rate is still up to 19%. Thus, it is necessary to find methods to reduce the recurrence rate.To investigate whether the perirenal pedicled fat tissue wadding technique during retroperitoneal laproscopic deroofing (RLD) of SRC affects the incidence of recurrence.A retrospective analysis was carried out on clinical data of 254 patients with SRC treated by RLD in our hospital from 2008 to 2016. Among these patients,119 had a simple retroperitoneal deroofing (SRD) and 135 received a retroperitoneoscopic deroofing with wadding of the cyst using perirenal fat tissue (RDCW). The recurrence rate and variables, as well as perioperative complications, were compared. To further explore the potential variables influencing cyst recurrence rate, univariate and multivariate regression analyses were applied.A total of 251 patients were included in the analysis. The operation was successfully completed laparoscopically in all cases with no conversion to open surgery. No mortality or significant complication occurred in both groups. After a median follow-up of 38.67 months, we noted 41 recurrences. According to the univariate and multivariate regression analyses, patients managed with the wadding technique had superior recurrence-free survival (RFS), compared with patients in SRD group (log-rank P = .03 and P = .04, respectively). Moreover, patients with single renal cyst had a lower recurrence rate, compared with patients with multiple renal cysts (log-rank P < .01). Regarding the operation time, blood loss, and hospital stay, no statistically significant difference was found between 2 groups (P values .13, .30, and .75, respectively). However, less postoperative drainage and shorter postoperative interval until tube removal (P = .04) were observed in RDCW group.The perirenal pedicled fat tissue wadding technique can decrease the cyst recurrence rate and RCDW represents an effective and safe treatment option in the management of renal cysts.
单纯性肾囊肿（SRC）的治疗选择包括开放手术、带剥除术的腹腔镜手术，或有无硬化治疗的经皮抽吸术。尽管腹腔镜去顶术比经皮硬化治疗取得更好的效果，但报道的复发率仍高达19%。因此，有必要找到降低复发率的方法。为了研究在SRC的后腹腔镜去顶术（RLD）期间肾周带蒂脂肪组织填充技术是否会影响复发率。对我院2008年至2016年采用RLD治疗的254例SRC患者的临床资料进行回顾性分析。在这些患者中，119例行单纯后腹腔镜去顶术（SRD），135例行后腹腔镜去顶术并使用肾周脂肪组织填充囊肿（RDCW）。比较复发率、变量以及围手术期并发症。为了进一步探讨影响囊肿复发率的潜在变量，应用单因素和多因素回归分析。共有251例患者纳入分析。所有病例均成功通过腹腔镜完成手术，无一例转为开放手术。两组均未发生死亡或严重并发症。中位随访38.67个月后，我们发现41例复发。根据单因素和多因素回归分析，与SRD组患者相比，采用填充技术治疗的患者无复发生存期（RFS）更好（对数秩检验P分别为0.03和0.04）。此外，与多发肾囊肿患者相比，单发肾囊肿患者的复发率更低（对数秩检验P<0.01）。关于手术时间、失血量和住院时间，两组之间未发现统计学上的显著差异（P值分别为.13、.30和.75）。然而，RDCW组术后引流量更少，直至拔除引流管的术后间隔更短（P=0.04）。肾周带蒂脂肪组织填充技术可降低囊肿复发率，RCDW是治疗肾囊肿的一种有效且安全的治疗选择。
