摘要
目的分析常染色体显性多囊肾病不同时期行腹腔镜去顶减压术的临床效果。方法选取2010年6月至2014年6月本院收治的常染色体显性多囊肾患者191例,术前采用CT测量双侧肾脏的长、宽、厚3径,计算肾脏体积,根据单侧肾脏体积将患者分为3组:A组,肾脏体积<500ml;B组,肾脏体积500~1500ml,C组肾脏体积>1500ml;术前采用双肾核素显像(ECT)测量患者双肾肾小球滤过率(GFR),3组患者均由同一医师主刀行单侧腹腔镜多囊肾去顶减压术,术后对比观察3组患者术侧术前及术后6、12、24个月GFR及腰痛、腹胀主观症状等方面的变化。结果各组对比术侧术前及术后6、12、24个月GFR的变化,A、C组提升差异无显著性(P>0.05),B组提升差异有显著性(P<0.01);术后腰痛、腹胀等主观症状改善情况,A组改善差异无显著性(P>0.05),B、C组均明显减少,差异有显著性。结论对于多囊肾患者,单侧肾脏体积在500~1500ml时,行腹腔镜多囊肾去顶减压术手术效果最佳,对延缓肾脏功能减退,保护肾脏功能作用最明显;单侧肾脏体积<500ml时,手术对于缓解肾脏压迫作用有限,可暂时不考虑手术治疗;肾脏体积>1500ml时,多数患者肾脏功能较差,手术对于延缓肾脏功能减退的作用有限,但可明显缓解腹部压迫、疼痛等症状。
Objective To investigate the effect of laparoscopic cyst decortication （LCD） in different stage of autosomal dominant polycystic kidney disease based on renal volume criterion in order to guide the clinical operation selection. Method The renal volume records of 191 consecutive patients who underwent unilateral laparoscopic cyst decortication from June 2010 to June 2014 were retrospectively reviewed. All patients were divided into 3 groups based on renal volume： group A were patients with renal volume〈500ml, group B 500- 1500ml, group C〉 1500ml. ECT was applied to detect bilateral GFR and backache and abdominal distension were also recorded to make comparisons before and after the surgery with a follow-up of 6, 12, 24 months. Result In light of the GFR before and 6, 12 and 24 months after the LCD, no visible changes were found in group A and C （P 〉0.05） but group B （P 〈0.01）. Backache, bloating and other subjective symptoms improved significantly in both B and C group. Conclusion Of all the patients with ADPKD who underwent LCD, the most favorable outcome and GFR improvement were found in those whose renal volume ranged from 500 to 1500ml while postponing the surgery for whose renal volume is 〈 500ml due to a limited impact was made for the recovery of renal function but dramatical outcome to relieve the complications such as abdominal oppression and pains for patients with renal volume〉 1500ml.
出处
《中国医刊》
CAS
2017年第11期41-43,共3页
Chinese Journal of Medicine
基金
山东省医药卫生科技发展计划(2014WS0085)
