血液透析患者腹腔镜胆囊切除术的临床分析  

Clinical analysis of laparoscopic cholecystectomy in patients undergoing hemodialysis

作　　者：张乐逸[1] 程震 嵇武[3] 丁凯[3] 张宇飞[1] 程东瑞 王丹[3] 李令堂[3] 

机构地区：[1]南京大学医学院临床学院 [2]解放军肾脏病研究所 [3]南京军区南京总医院解放军普通外科研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2009年第2期121-124,147,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:探讨血液透析(HD)患者腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的安全性、可行性与技术特点。方法:38例HD行LC的患者为观察组,同期38例肾功能正常行LC的患者为对照组,比较观察组手术前后肾功能的改变,比较两组术前一般情况(凝血酶原时间、血压、血红蛋白)、手术成功率、手术时间、术中出血量、恢复通气时间、并发症发生率、住院时间和住院费用(观察组扣除血液透析费用)。结果:观察组术前和术后第1天、第3天BUN分别为(19.26±14.83)mmol/L、(22.52±10.67)mmol/L、(18.16±8.76)mmol/L,SCr分别为(518.42±268.77)μmol/L、(539.29±256.50)μmol/L、(529.24±226.85)μmol/L,Hb分别为(98.39±18.23)g/L、(97.16±17.36)g/L、(97.47±17.28)g/L,均无显著差异(P>0.05)。二组在术前收缩压、Hb、凝血酶原时间的差异统计学差异显著(P<0.05),余手术成功率、手术时间、术中出血量、恢复通气时间、并发症发生率、住院时间和住院费用等方面无显著差异(P>0.05)。结论:HD患者行LC手术是安全的、可行的,应把握合理的手术适应证,尤其要注重围手术期的处理。Objective ：To investigate the safety, feasibility and character of laparoscopic cholecystectomy （LC） in patients undergoing hemodialysis. Methodology：Seventy six patients receiving LC were enrolled in this study. 38 cases undergoing hemodialysis were regarded as observe group and another 38 cases without renal insufficiency during the same period as control group. The preoperative and postoperative renal function of observe group was compared. The preoperative general situation（ included prothrombin time, blood pressure, hemoglobin ） , success rate of operation, operative duration, intraoperative blood loss, first exhaust time, complication rate, length of stay and total cost（without the expense of hemodialysis in observe group） between the two groups were collected and retrospectively analyzed. Results：In observe group, no significant differences were found in the levels of blood urea nitrogen [ （ 19. 3 ± 14. 8 ） mmol/L, （ 22. 5 ± 10. 7 ） mmol/L, （ 18.2 ± 8.76 ） mmol/L ] , serum creatinine [ （ 518 ± 269 ） μmol/L, （ 539 ± 257 ） μmol/L, （ 529 ± 227 ） μmol/L], hemoglobin [ （98.4 ± 18.2） g/L, （97.2 ± 17.4） g/L, （97.5 ± 17.3 ） g/L] between the preoperative and postoperative time containing the 1st and 3rd day after operation （P 〉 0.05 ）. There were significant differences in SBP, prothrombin time, hemoglobin between two groups, but no significant differences in the success rate of operation, operative duration, intraoperative blood loss, first exhaust time, complication rate, length of stay and total cost （ P 〉 0. 05 ）. Conclusion：LC is a feasible and safe procedure for chronic renal insufficiency patients undergoing hemodialysis. It is important to get the appropriate indications of the operation and pay more attention to the periperative management.

关 键 词：腹腔镜胆囊切除术 血液透析 肾移植 

分 类 号：R657.4[医药卫生—外科学] R459.5[医药卫生—临床医学]