标题：单孔后腹腔镜术与肾囊肿穿刺硬化术治疗肾囊肿的疗效和安全性研究

      作者：孙振业，付强，姚振，高闫尧，王磊    空军军医大学第二附属医院泌尿外科，陕西 西安 710038

      卷次： 2023年34卷3期

      【摘要】 目的 比较单孔后腹腔镜术与肾囊肿穿刺硬化术治疗肾囊肿的疗效和安全性。方法 前瞻性选取2017年3月至2019年12月空军军医大学第二附属医院泌尿外科收治的106例肾囊肿患者为研究对象，按照随机数表法分为对照组和观察组，每组53例。对照组患者采取单孔后腹腔镜术，观察组患者采取肾囊肿穿刺硬化术，比较两组患者的临床疗效、住院天数、治疗费用、术后视觉模拟(VAS)评分、相关应激指标水平和术后并发症发生情况、复发率。结果 观察组患者的临床治疗总有效率为 100.00%，明显高于对照组的 88.68%，差异有统计学意义(P<0.05)；观察组患者的住院天数为(3.21±1.25) d，明显短于对照组的(4.82±1.26) d，治疗费用为(3 524.9±513.9)元，明显少于对照组的(9 523.4±542.1)元，差异有统计学意义(P<0.05)；术后，观察组患者的VAS评分为(2.02±0.54 )分，明显低于对照组的(3.12±0.92)分，差异有统计学意义(P<0.05)；两组患者治疗前的外周血皮质醇和促甲状腺激素(TSH)水平比较差异均无统计学意义(P>0.05)；术后3 d，观察组患者的外周血外周血皮质醇和TSH水平分别为(48.21±10.63) nmol/L、(3.71±1.26) uIU/mL，明显低于对照组的(54.32±11.32) nmol/l、(4.32±1.22) uIU/mL，差异均有统计学意义(P<0.05)；观察组患者并发症发生率为3.77%，明显低于对照组的16.98%，但复发率为9.43%，明显高于对照组的0，差异均有统计学意义(P<0.05)。结论 肾囊肿穿刺硬化术具有较好的临床应用效果，操作简单，费用较低，但复发率偏高。单孔后腹腔镜术住院时间较长，并发症高，但复发率低，临床上需要根据患者的实际情况选择合适的术式。
      【关键词】 肾囊肿；单孔后腹腔镜术；肾囊肿穿刺硬化术；应激反应；疗效；安全性
      【中图分类号】 R692.1+2 【文献标识码】 A 【文章编号】 1003—6350（2023）03—0344—04

Efficacy and safety of single-port retroperitoneal laparoscopic surgery and renal cyst puncture sclerotherapy inthe treatment of renal cysts.
SUN Zhen-ye, FU Qiang, YAO Zhen, GAO Yan-yao, WANG Lei. Department of Urology, theSecond Affiliated Hospital of Air Force Medical University, Xi'an 710038, Shaanxi, CHINA
【Abstract】 Objective To compare the efficacy and safety of single-port retroperitoneal laparoscopic surgeryand renal cyst puncture sclerotherapy in the treatment of renal cysts. Methods A total of 106 patients with renal cystsadmitted to the Department of Urology, the Second Affiliated Hospital of Air Force Medical University from March2017 to December 2019 were prospectively selected as the research objects. According to the random number table meth-od, they were divided into a control group and an observation group, with 53 patients in each group. Patients in the con-trol group were treated with single-port retroperitoneal laparoscopic surgery, and patients in the observation group weretreated with renal cyst puncture sclerotherapy. The clinical efficacy, length of hospital stay, treatment costs, postoperativeVisual Analogue Scale (VAS) score, related stress index levels, postoperative complications, and recurrence rate werecompared between the two groups. Results The total effective rate of clinical treatment in the observation group was100.00%, which was significantly higher than 88.68% in the control group (P<0.05). The length of hospital stay in theobservation group was (3.21±1.25) d, which was significantly shorter than (4.82±1.26) d in the control group, and thetreatment cost was (3 524.9±513.9) yuan, significantly less than (9 523.4±542.1) yuan in the control group (P<0.05). Af-ter the operation, the VAS score in the observation group was (2.02±0.54) points, which was significantly lower than(3.12±0.92) points in the control group (P<0.05). There was no significant difference in the levels of peripheral blood corti-sol and thyroid stimulating hormone (TSH) between the two groups before treatment (P>0.05). Three days after surgery, thelevels of peripheral blood cortisol and TSH in the observation group were (48.21±10.63) nmol/L and (3.71±1.26) uIU/mL,respectively, which were significantly lower than (54.32±11.32) nmol/L and (4.32±1.22) uIU/mL in the control group(P<0.05). The incidence of complications in the observation group was 3.77% , which was significantly lower than16.98% in the control group, and the recurrence rate was 9.43%, significantly higher than 0 in the control group (P<0.05). Conclusion Renal cyst puncture sclerotherapy has good clinical application effect, simple operation and lowcost, but the recurrence rate is high. Single-port retroperitoneal laparoscopic surgery has a longer length of hospital stayand higher complications, but the recurrence rate is low. Clinically, it is necessary to choose the appropriate surgicalmethod according to the actual situation of patients.
      【Key words】 Renal cyst; Single-port retroperitoneal laparoscopic surgery; Renal cyst puncture sclerotherapy;Stress response; Efficacy; Safety