Comparative Study Of Three Minimally Invasive Surgical Treatment Of Renal Cysts

Objective: With the improvement of the detection rate of renal cysts, more and morepatients need interrelated treatment, at present domestic and foreign scholars areinclined to minimally invasive direction in this disease. Minimally invasive surgery ofthis subject contain the cyst unroofing surgery by retroperitoneal way in laparoscopicsurgery, sclerotherapy of renal cyst puncture guided by B ultrasound, and our hospitaltrial of transurethral ureteroscopy renal cystincision and drainage. The main purposeof this project is to compare the pros and cons of the three kinds of operation methodand to explore selections of renal cyst minimally invasive surgery.Methods: We collected and analyzed clinical datas from urology hospitalized andsurgical treatment patients from Qinghai Province People’s Hospital during March2011to November2012, compar patient’s operative time, intraoperative blood loss,average hospitalization time, cost of treatment, the cure rate, and with and withoutrecurrence were compared in different surgical treatment.Results: Compared with other two groups, puncture sclerotherapy group’s operativetime was the shortest and it was (29.8±3.3) min, postoperative averagehospitalization time was the shortest and it was (1.5±0.5) d, cost of treatment was thelowest and as low as (3261.8±779.2) yuan and cure rate is75%. Intraoperative bloodloss of the laparoscopic group was (29.9±3.1) ml, cost of treatment was (9050.9± 1116.2) yuan, operative time was (62.0±10.2) min, postoperative averagehospitalization time was (4.0±0.8) d and cure rate is100%. Operative time ofureteroscopy group was (89.5±3.0) min, intraoperative blood loss was (49.5±3.0)ml, cost of treatment was (6360.0±748.3) yuan, postoperative averagehospitalization time was (3.5±0.5) d and cure rate is30%. There is significantdifference among three groups in operative time, intraoperative blood loss,postoperative average hospitalization time, cost of treatment and cure rate afterstatistical analysis, and there was statistically significant (p<0.05). There wasstatistically significant after multiple comparisons(p<0.05).All patients were followedup for5-21months6cases of them were was relapsed in puncture sclerosis group, therecurrence rate was30%, and the remaining two groups showed no recurrence.Conclusions:1. Although puncture group in blood loss, operative time, postoperative hospital stay,cost of treatment is better than the other two groups, and surgeon can observe thetip and the cyst size according to B-dynamic in puncture and extraction of the cystfluid and precision is high, cure rate is as low as75%and follow-up recurrencerate postoperative is up to30%. Literature have reported the surgical have manycomplications, such as hardener mistakenly noting, hardener extravasating,perirenal bleeding, adjacent organ damaging and so on. So the operation issuitable for implementation in the primary hospitals which have no laparoscopicequipment and technology or the patients are poor state and can not tolerateanesthesia with epidural anesthesia.2. Although the ureteroscopy kidney cyst is a natural orifice transluminal endoscopicsurgery and fit to the characteristics of human physiology, it should not be used as a conventional method in dealing with simple renal cysts for many problems.When patients have an operation on includeing the neighboring organs such as theliver, spleen and kidneys open surgery for patients have partial adhesions, obese,or can not be after laparoscopic surgery under general anesthesia combiningwith severe cardiovascular diseases, or B ultrasound-guided is unable to positionaccuratly, such as block of the liver, spleen, more accumulated gas in the intestine,associated with hydronephrosis, the ureteroscopy kidney cyst can be considered.3. Retroperitoneal laparoscopic kidney cyst is still the preferred technique and thegold standard in the treatment of renal cysts, and appling to the vast majority ofrenal cysts (including the ureter entering into the mirror difficultly for variouscauses instead of other surgical cystlocated in the surface of the kidney cysts andthick-walled cysts, etc.), but the cost is high and one operation can handle onlyone side of kidney cysts and cyst blocking infection required reoperationoperation more difficult, long-term recurrence rate still need to be furtherobserved and accumulated.