去顶减压术治疗成人多囊肾病的疗效分析  

Therapeutic effectiveness of decortication in treatment of Ⅰ and Ⅱ stage ADPKD

作　　者：钱小强[1] 齐隽[2] 陈建华[2] 李爱华[1] 陆鸿海[2] 盛旭俊[1] 于国鹏[2] 

机构地区：[1]同济大学附属杨浦医院,上海200090 [2]上海交通大学附属新华医院

出　　处：《临床肾脏病杂志》2011年第10期463-466,共4页Journal Of Clinical Nephrology

摘　　要：目的探讨去顶减压术在治疗成人常染色体显性遗传多囊肾病（ADPKD）中的疗效。方法回顾性分析137例ADPKD患者的临床资料，把多囊肾病分为3个临床阶段，其中70例Ⅰ期和Ⅱ期多囊肾病患者行去顶减压术，观察围术期各个指标、术后第1、3年的肾功能、血压、肾脏体积和腰背酸痛演变的临床疗效。结果去顶减压术的70例患者中，I期与Ⅱ期患者围术期在手术时间和术中出血量上有明显差异（P〈0．05），在术后肠道排气时间、术后止痛药物剂量和术后住院天数无明显差异（P〉0．05）。工期患者术后第1、3年的SCr均能保持正常范围，与术前无明显差异（P〉0．05）。Ⅱ期患者术后第1年SCr有明显改善（P〈0．05），但术后第3年SCr与术前无明显差异（P〉0．05）。Ⅰ、Ⅱ期患者术后第1年腰背疼痛视觉模拟评分法（VAS评分）、收缩压、舒张压有明显差异（P〈0．05），术后第3年VAS评分、收缩压、舒张压与术前无明显差异（P〉0．05）。结论对I期ADPKD患者，去顶减压术对缓解腰背酸痛症状、改善高血压，短期1年内有明显的疗效，但术后3年疗效不明显；术后1～3年SCr能够保持正常。对Ⅱ期ADPKD患者，去顶减压术短期1年内有明显改善肾功能疗效，术后第3年肾功能恢复到术前水平；且手术难度和风险有所增加。Objective To study the effectiveness of decortication in the treatment of adult auto-somal dominant polycystic kidney disease（ADPKD）. Methods We analyzed 137 cases of ADPKD ret-rospectively between 2001 to 2010. The patients with ADPKD were divided into three clinical stages. Seventy cases of Ⅰ and Ⅱ stages underwent decortication, and the various indicators during operation, the kidney function, blood pressure, kidney volume and back pain （VAS score） 1 and 3 years after operation were observed. Results In 70 patients undergoing decortication surgery, there was significant difference in the operation time and blood loss between the Ⅰ and Ⅱ stages （P〈0. 05）, but no significant difference was found in the postoperative bowel discharge time, postoperative pain medication dose and postoperative hospital stay （P〉0. 05）. The SCr levels in the patients with Ⅰ stage were normal 1 and 3 years after operation,and there was no significant difference before and after operation （P〉0. 05）. The SCr levels in patients with Ⅱ stage were significantly reduced at the first postoperative year （P〈0. 05）, but they was no significant difference at the third postoperative year （P〉0. 05）. At the first postoperative year, there was significant difference in back pain（VAS）, systolic blood pressure,diastolic blood pressure （P〈0. 05） in the patients with Ⅰ and Ⅱ stage, but three years later, there was no significant difference （P〉0. 05）. Conclusions Decortication in ADPKD patients of Ⅰ stage can alleviate back pain symptoms and reduce high blood pressure within one year, but the long-term effects of 3 years are not ideal. SCr levels 1 to 3 years after operation are normal. For ADPKD patients with II stage, decortication can improve significantly the renal function in a short-time of 1 year,but the renal function after 3 years returns to the preoperative levels, and the surgical difficulty and postoperative complications are also increased.

关 键 词：常染色体显性多囊肾病 血压 治疗效果 

分 类 号：R692.12[医药卫生—泌尿科学]