Clinical Observation Of Different Operation Modes For The Treatment Of Simple Renal Cyst

Objective:This study through the comparison of clinical curative efifection in the management of simple renal cyst among the open renal cyst unroofing,laparoscopic renal cyst unroofing,open renal parenchyma incision drainage,laparoscopic renal parenchyma incision drainage,percutaneous nephroscope and ureteroscope incision drainage by using holmium laser.To investigate the clinical application value of ureteroscope and percutaneous nephroscope for the treatment of simple renal cyst.Methods:From Jan.2007 to Mar.2015,218 cases of patient with simple renal cyst were underwent surgical treatment in the Department of Urology,First people’s hospital of yunnan province.Collecting and retrospective analyzing the clinical data and telephone follow-up information of all the patient.Among them,63 cases of renal peripheral superficial cyst were in the first group,14 cases were handled with open renal cyst unroofing,49 cases were taken with laparoscopic renal cyst unroofing.43 cases of renal peripheral deep cyst were in the second group,7 cases were taken with open renal cyst unroofing,15 cases were taken with laparoscopic renal cyst unroofing,15 cases were taken with percutaneous nephroscope incision drainage by using holmium laser through "skin�'cyst�'pelvis" or "skin�'pelvis�'cyst" tunnel,6 cases were taken with flexible or conventional ureteroscope incision drainage by using holmium laser through "urethra�'pelvis�'cyst" tunnel.40 cases of renal parapelvic superficial cyst were in the third group,10 cases were taken with open renal cyst unroofing,10 cases were taken with laparoscopic renal cyst unroofing,7 cases were taken with percutaneous nephroscope incision drainage by using holmium laser through "skin�'pelvis�'cyst" tunnel,13 cases were taken with flexible or conventional ureteroscope incision drainage by using holmium laser through "urethra�'pelvis�'cyst" tunnel.72 cases of renal parapelvic deep cyst were in the forth group,10 cases were taken with open renal parenchyma incision drainage,15 cases were taken with laparoscopic renal parenchyma incision drainage,22 cases were taken with percutaneous nephroscope incision drainage by using holmium laser through "skin�'yst�'pelvis" or "skin�'pelvis�'cyst" tunnel,25 cases were taken with flexible or conventional ureteroscope incision drainage by using holmium laser through "urethra�'pelvis�'cyst" tunnel.All of the patient in the four groups,their situation,such as operation time,intraoperative blood loss,accuracy of cyst positioning, damage of renal parenchyma,intraoperative and postoperative complications, postoperative relapse were analyzed.Taking SPSS 17.0 statistical software package to analyze all of the data,the date of renal peripheral superficial cyst group was taken with X2 test,the date of renal peripheral deep cyst group,renal parapelvic superficial cyst group and renal parapelvic deep cyst group,measuring index were taken with F test,count indicators were taken with q test,inspection level is 0.05.Results:1、renal peripheral superficial cyst group(1) open renal cyst unroofing:The average operation time,average intraoperative blood loss and average day in hospital are (63±13)min,(30±15)ml and (6±1)d, respectively.(2) laparoscopic renal cyst unroofing:The average operation time,average intraoperative blood loss and average day in hospital are (55±11)min,(20±11)ml and (4±1)d, respectively.(3) The average operation time,average intraoperative blood loss and average day in hospital of laparoscopic renal cyst unroofing are less than the open renal cyst unroofing, the difference has statistically significant(P<0.05).2, renal peripheral deep cyst group(1) The average operation time:percutaneous nephroscope surgical(49±12)min has no statistically significant with ureteroscope surgical(47±11)min(P>0.05),but are less than the laparoscopic surgery(55±11)min and the open surgery(63±13)min, the difference has statistically significant(P<0.05).(2) The average intraoperative blood loss:percutaneous nephroscope surgical(20±12)ml has no statistically significant with laparoscopic surgery(20±10)ml (P>0.05),but are less than the open surgery(30±15)ml, the difference has statistically significant(P<0.05).(3) The average day in hospital:percutaneous nephroscope surgical(5±1)d, ureteroscope surgical(4±2)d,laparoscopic surgery(4±1)d,has no statistically significant (P>0.05),but are less than the open surgery(6±1)d,the difference has statistically significant(P<0.05).3、renal parapelvic superficial cyst group(1) The average operation time:percutaneous nephroscope surgical(49±12)min has no statistically significant with ureteroscope surgical(47±11)min(P>0.05),but are less than the laparoscopic surgery(63±7)min and the open surgery(75±9)min, the difference has statistically significant(P<0.05).(2) The average intraoperative blood loss:percutaneous nephroscope surgical(20±12)ml has no statistically significant with laparoscopic surgery (22±9)ml (P>0.05),but are less than the open surgery(33±15)ml,the difference has statistically significant(P<0.05).(3) The average day in hospital:percutaneous nephroscope surgical(5±1)d, ureteroscope surgical(4±2)d,laparoscopic surgery(4±1)d,has no statistically significant (P>0.05),but are less than the open surgery(6±1)d,the difference has statistically significant(P<0.05).4、renal parapelvic deep cyst group(1) The average operation time:percutaneous nephroscope surgical(49±12)min has no statistically significant with ureteroscope surgical (47±11)min (P>0.05),but are less than the laparoscopic surgery(76±18)min and the open surgery(94±9)min,the difference has statistically significant(P<0.05).(2) The average intraoperative blood loss:percutaneous nephroscope surgical(20±12)ml is less than the laparoscopic surgery(50±25)ml and the open surgery(75±25)ml, the difference has statistically significant(P<0.05).(3) The average day in hospital:percutaneous nephroscope surgical(5±1)d, ureteroscope surgical(4±2)d,has no statistically significant(P>0.05),but are less than laparoscopic surgery(10±3)d and the open surgery(14±5)d, the difference has statistically significant(P<0.05).Conclusion:1、renal peripheral superficial cyst,choosing laparoscopic surgery has the advantages of minimally invasive,simple operation,shorter hospital stay.Comparing with open surgery,has obvious advantages.2、renal peripheral deep and renal parapelvic superficial cyst:ureteroscope, percutaneous nephroscope and laparoscopic surgery are have obvious advantages.But the percutaneous nephroscope and the ureteroscopy operation are use minimally invasive and the natural tunnel,comparing with laparoscopic,has the advantages of less damage and easier operation.3、renal parapelvic deep cyst:establishing the individual surgical approach according to it’s characterize,taking ureteroscope and percutaneous nephroscope operation have the advantages of minimally invasive,shorter operation time,lower recurrence after postoperation.Comparing with open surgery and laparoscopic surgery.it has good clinical application value.