复杂性肾囊肿的术前诊断与外科治疗

Preoperative diagnosis and surgical treatment of complex renal cysts

摘要

肾囊肿是泌尿外科常见的疾病，囊肿体积的增大可能引发疼痛、感染、出血等症状，甚至影响肾脏功能。单纯性肾囊肿恶性风险较低，一般不处理或者选单纯性肾囊肿去顶术急性治疗。复杂性肾囊肿存在着不同程度的恶性风险。在Bosniak Ⅲ级及以上时，恶性风险较高，影像学等检查可能对判断恶性风险及与恶性肾肿瘤的鉴别有帮助。对复杂性肾囊肿的术前充分评估，根据不同的恶性风险选择不同的手术方式以及避免术中囊肿破裂所带来的可能的恶性肿瘤细胞的播散，在复杂性肾囊肿患者的预后很重要。本文将重点讨论复杂性肾囊肿的术前评估，复杂性肾囊肿的外科治疗方法，囊肿处理时避免其破裂的技术要点，囊肿破裂的补救措施等，以期进一步改善复杂性肾囊肿患者的预后。

Abstract

Renal cysts are a common disease in the field of urology，and the increase in cyst volume can lead to various symptoms such as pain，infection，and bleeding and even affect renal function. Simple renal cysts have a low risk of malignancy and generally do not require treatment，and simple renal cyst unroofing can be selected for acute treatment. Complex renal cysts have varying degrees of malignancy risk，and patients classified as Bosniak grade Ⅲ or higher tend to face a relatively high risk of malignancy. Radiological examination may help to determine the risk of malignancy and perform differential diagnosis of malignant renal tumors. Adequate preoperative evaluation of complex renal cysts，selection of different surgical procedures according to the risk of malignancy，and avoidance of possible dissemination of malignant cells caused by intraoperative rupture of cysts are very important for the prognosis of patients with complex renal cysts. This article focuses on the preoperative evaluation and surgical treatment of complex renal cysts，the key technical points to avoid its rupture during the treatment of cysts，and the remedial measures for cyst rupture，in order to further improve the prognosis of patients with complex renal cysts.

关键词

复杂性肾囊肿 / 术前诊断 / 外科治疗

Key words

complex renal cysts / preoperative diagnosis / surgical treatment

基金资助

国家自然科学基金资助项目(82273389)