肾癌合并尿毒症透析患者的后腹腔镜手术治疗及围手术期综合处理  

Laparoscopic Surgery and Combined Perioperative Management of Kidney Cancer Patients Accompanied with Uremia in Hemodialysis

作　　者：朱遵伟[1] 周杰[1] 熊焕腾[1] 朱心燊[1] 陈耀辉[1] 周绪锋[1] 曾涛[1] 黄辉[1] ZHU Zunwei;ZHOU Jie;XIONG Huanteng(Jiangxi Province People’s Hospital,Nanchang 330006,China)

机构地区：[1]江西省人民医院,江西南昌330006

出　　处：《中国医学创新》2018年第7期91-95,共5页Medical Innovation of China

基　　金：江西省科技厅社会发展领域课题(20141BBG70046)

摘　　要：目的:分析7例肾癌合并尿毒症透析患者行后腹腔镜手术治疗及围手术期处理的经验。方法:对本科2013年1月-2016年2月期间7例肾癌合并尿毒症患者实施后腹腔镜下根治性肾切除术,分析患者行后腹腔镜手术治疗及围手术期的综合处理情况。结果:7例手术时间67~115 min,平均(87±12.5)min;术中出血量55~120 m L,平均(82.0±13.5)m L,术中生命体征及循环稳定。1例在术后5 d出现急性心功能衰竭,经强心、利尿等抢救后心功能恢复,术后病理均为肾透明细胞癌。结论:对于肾癌合并尿毒症患者实施后腹腔镜根治性肾切除手术治疗,需严格术前准备及评估,术中有效麻醉监护及技术操作,术后控制液体摄入量,加强围手术期综合处理,保障尿毒症患者医疗安全和治疗效果。Objective:To analyze clinical experience in laparoscopic surgery and perioperative management of 7 kidney cancer patients accompanied with uremia in hemodialysis.Method:7 kidney cancer patients accompanied with uremia in our department were selected from January 2013 to February 2016,they were given radical nephrectomy.The comprehensive treatment of patients undergoing retroperitoneal laparoscopic surgery and perioperative period were analyzed.Result:The operation time was about 67-115 min,average(87.0±12.5)min;operative blood loss about 55-120 mL,average(82.0±13.5)mL.The vital signs during operation were stable.1 case had acute heart failure at the fifth day after surgery,but recuperated after emergency treatment.Their postoperative pathologic results were all renal clear cell carcinoma.Conclusion:To have laparoscopic radical nephrectomy for kidney cancer patients accompanied with uremia,we must have good preoperative preparation,monitoring andcontrol the effect of anaesthesia during operation,restriction of fluid intake after the operation,and reinforce combined perioperative management for medication safety and treatment effect.

关 键 词：肾癌 尿毒症 腹腔镜 综合治疗 根治性肾切除 

分 类 号：R699[医药卫生—泌尿科学] R737.11[医药卫生—外科学]