摘要
目的 终末期肾病患者施行肾移植手术时并发症较多,而且伴有胆结石及胆囊病变风险,严重者可危及生命。因此,处理肾移植术前患者所合并的胆囊结石值得重视。本文旨在探讨终末期肾病（ESRD）合并胆囊结石的患者行腹腔镜胆囊切除术（LC）的围手术期麻醉处理要点,以评价终末期肾病患者进行胆囊切除术的安全性。方法 收集23例ESRD合并胆囊结石患者进行LC的临床资料,其中男性13例,女性10例,年龄36-56岁,平均年龄为（49.8±11.9）岁,所有患者均经B超确诊为合并胆囊结石,其中慢性肾小球肾炎肾病15例,痛风性肾病3例,狼疮肾病2例,紫癜肾3例。分别记录并比较术前1 d、术后1 d与术后3 d的肾功能指标,采用配对样本t检验进行统计学分析。结果 23例ESRD患者均顺利完成LC手术,麻醉效果良好。术后1 d和术后3 d的肾功能指标分别于术前1 d相比,差异均无统计学意义（P〉0.05）;其中22例患者均于术后30 min内拔除气管导管,只有1例患者发生肺水肿,经治疗后好转。住院天数为3-13 d,平均7 d,术后抗菌素使用为平均1.42 d,手术效果和恢复效果良好。结论 ESRD患者在肾移植前有必要手术治疗胆囊结石,LC术不会引起患者肾功能恶化且安全有效,充分的围手术期准备和麻醉处理是手术成功的关键。
Objective The patients with end-stage renal disease had more complication in kidney transplant surgery accompanied with gall-stone and Gallbladder disease risk. Hence,it was worthy of paying more attention to merger of gallstones in kidney transplant surgery. This article was aimed at discussing the anesthesia disposal emphasis of patients with end-stage renal disease combined gallstones for laparoscopic cholecystectomy in perioperative period and evaluating the safety. Methods The clinical data involved twenty-three cases of patients with ESRD combined gallstones for LC were collected and including thirteen cases of male,ten cases of female. The age ranged between 36 to 56 years and the average age was（ 49. 8 ± 11. 9） years. All patients were diagnosed as combined gallstones by B ultrasound and including fifteen cases of chronic glomerulonephritis kidney disease,three cases of gouty nephropathy,two cases of lupus nephropathy and three cases of purpuric nephropathy. The renal function of preoperative one day,postoperative one day and postoperative three days were recorded and compared with pared-samples T test for statistical analysis. Results Twenty three cases of patients with ESRD all completed the LC operation smoothly and anesthesia effect was good. The renal function of postoperative one day and postoperative three days were all no significant statistical significance（ P〉0. 05） compared with preoperative one day. Among them,twenty-two cases of patients were pulled out the endotracheal tube in 30 min after operation and one case of patient was found emphysema which improved after treatment. The length of stay range was between three to thirteen days and the average was seven days. The average days of using antibiotic was 1. 42 d which accompanied with good surgical and recovery effect. Conclusion It was necessary for patients with ESRD to conduct surgical treatment of gallbladder stones and LC did not cause deterioration of renal function in patients with safety and efficacy. Fully preparing for the peri-operative treatment and anesthesia disposal were the key to the success of surgery.
出处
《中华全科医学》
2015年第2期222-224,共3页
Chinese Journal of General Practice
关键词
胆囊结石
肾移植
终末期肾病
腹腔镜胆囊切除术
围手术期
麻醉处理
Gallstone
Renal transplant
End-stage renal disease
Laparoscopic cholecystectomy
Perioperative period
Anesthesia disposal
