慢性肾功能不全氮质血症期患者腹腔镜胆囊切除术的临床分析  

Clinical analysis of laparoscopic cholecystectomy in patients with chronic renal dysfunction at azotaemic stage

作　　者：刘军[1] 金岚[1] 张忠涛[1] 

机构地区：[1]首都医科大学附属北京友谊医院普外科,北京100050

出　　处：《中国微创外科杂志》2007年第7期676-677,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨慢性肾功能不全氮质血症期的患者行腹腔镜胆囊切除（laparoscopic cholecystectomy,LC）的可行性与安全性。方法 分析2004年5月～2006年9月7例合并慢性肾功能不全氮质血症期LC的临床资料。气管插管全麻。CO2气腹压力维持在9～12 mm Hg,5例行三孔法LC,2例改为四孔法LC。结果 7例均顺利完成手术,肾功能不全无加重。术前、术后血尿素氮[（11.92±4.06）mmol/L vs（12.16±3.76 mmol/L,t=0.50,P=0.633）]和血肌酐[（208.62±134.37）μmol/L vs（204.20±125.53）μmol/L,t=0.51,P=0.626]差异无显著性。3例肌酐清除率术前、术后2周无明显改变（40.03ml/min vs 45.61 ml/min;32.28 ml/min vs 38.93 ml/min;56.72 ml/min vs 51.60 ml/min）。随访4～20个月,平均10个月,肾功能无改变。结论 合并慢性肾功能不全的LC是安全、可行的,应注意术中气腹压力的控制和围手术期处理。Objective To investigate the feasibility and safety of laparoscopic cholecystectomy （LC） in patients with chronic renal dysfunction at azotaemic stage. Methods Clinical data of 7 patients accompanying chronic renal dysfunction at azotaemic stage treated with LC between May 2004 and September 2006 were analyzed retrospectively. The operation was performed under general anesthesia and endotracheal intubation. The CO2 pressure was maintained at 9 - 12 mm Hg. The LC was conducted with 3-port technique in 5 patients and 4-port.technique in 2. Results The LC was completed smoothly in all the 7 patients. Patients＇ renal dysfunction was not aggravated. There was no significant difference between pre- and post-operative time in levels of blood urea nitrogen （11.92± 4.06mmol/L vs 12. 16 ± 3.76 mmol/L; t = 0.50, P = 0. 633 ） and blood creatinine （208. 62 ± 134. 37 μmol/L vs 204.20 ± 125.53 μmol/L; t = 0.51, P = 0. 626 ）. As compared with preoperative levels, the creatinine clearance rates were not significantly changed at 2 weeks after operation in 3 patients （40.03 ml/min vs 45.61 ml/min; 32.28 ml/min vs 38.93 ml/min; 56. 72 ml/min vs 51. 60 ml/min ）. Follow-up checkups for 4 - 20 months （ mean, 10 months ） showed no aggravation of renal dysfunction. Conclusions Laparoscopic cholecystectomy is a feasible and safe procedure for patients with chronic renal dysfunction at azotaemic stage.

关 键 词：腹腔镜胆囊切除术 肾功能不全 

分 类 号：R692.5[医药卫生—泌尿科学]