预防性切除原位多囊肾对ADPKD患者肾移植围手术期并发症及手术难度的影响  

Influence of prophylactic resection of orthotopic polycystic kidney disease on perioperative complications and surgical difficulty of renal transplantation in patients with ADPKD

作　　者：朱一辰[1] 吕竟成 杜春凯 郭宇文[1] 王志鹏[1] 张健[1] Zhu Yichen;Lyu Jingcheng;Du Chunkai;Guo Yuwen;Wang Zhipeng;Zhang Jian(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京100050

出　　处：《国际外科学杂志》2022年第6期399-404,I0004,共7页International Journal of Surgery

基　　金：北京市医院管理中心"青苗"计划专项经费资助(QMS20180104)。

摘　　要：目的探究因常染色体显性遗传多囊肾病(ADPKD)导致终末期肾病的患者,在同种异体肾移植术前预防性切除原位多囊肾,是否可以降低围手术期并发症的发生率及严重程度并降低手术难度。方法采用回顾性病例对照研究方法,纳入2013年1月—2021年1月于首都医科大学附属北京友谊医院诊断为ADPKD并行同种异体肾移植术的患者共27例。按患者移植前是否预防性切除原位多囊肾,分为预防性切除组(n=19)和未预防性切除组(n=8)。预防性切除组患者移植前切除原位多囊肾,未预防性切除组患者移植前未切除原位多囊肾。分析并对比两组患者肾移植术前血红蛋白、血小板、白蛋白、左室室壁厚度、左室射血分数、肾移植手术难度及术后平均住院时间、疼痛情况、并发症发生率等指标。计量资料以均数±标准差(±s)表示,组间比较采用独立样本t检验;计数资料组间比较采用χ^(2)检验。结果两组患者肾移植术前血红蛋白、血小板、白蛋白、左室室壁厚度、左室射血分数等一般状态比较,差异均无统计学意义(P>0.05)。但预防性切除组患者多囊肾体积[(2409.8±1899.8)cm^(3)]大于未预防性切除组[(1340.2±290.6)cm^(3)],差异具有统计学意义(P=0.027)。在术后并发症方面,预防性切除组及未预防性切除组中分别有9例和5例患者出现了移植术后长期腰痛或血尿,均考虑与未切除侧多囊肾相关,但差异无统计学意义(P=0.678)。同时,两组中均有3例患者因出现严重多囊肾并发症,在移植术后行原位多囊肾切除术。虽然预防性切除组并发症发生率(15.8%)低于未预防性切除组(37.5%),但差异无统计学意义(P=0.319)。结论肾移植术前预防性切除原位多囊肾可以降低移植术后多囊肾相关并发症的发生率及严重程度,但对肾移植手术时间及术中出血量影响不明显。Objective To explore whether prophylactic resection of orthotopic polycystic kidney before allogeneic kidney transplantation can reduce the incidence and severity of perioperative complications in patients with end-stage renal disease due to autosomal dominant polycystic kidney disease(ADPKD),and reduce the difficulty of surgery.Methods A retrospective case-control study method was used to recruit a total of 27 patients who were diagnosed with ADPKD and underwent allogeneic kidney transplantation in Beijing Friendship Hospital,Capital Medical University from January 2013 to January 2021,they were divided into prophylactic resection group(n=19)and non-prophylactic resection group(n=8)according to whether orthotopic polycystic kidney disease was prophylactic resection before transplantation.Patients in prophylactic resection group underwent orthotopic polycystic kidney resection before transplantation,while patients in non-prophylactic resection group didn′t.The indexes such as hemoglobin,platelet,albumin,left ventricular wall thickness,left ventricular ejection fraction,difficulty of kidney transplantation,average postoperative hospital stay,pain,and complication rate before kidney transplantation were analyzed and compared between the two groups.Measurement data were expressed as mean±standard deviation(±s),and independent sample t-test was used for comparison between groups;Chi-square test was used for comparison of enumeration data between groups.Results There was no significant difference in the general status of hemoglobin,platelets,albumin,left ventricular wall thickness,and left ventricular ejection fraction between the two groups before kidney transplantation(P>0.05).However,the polycystic kidney volume[(2409.8±1899.8)cm^(3)]in the prophylactic resection group was greater than that in the non-prophylactic resection group[(1340.2±290.6)cm^(3)],and the difference was statistically significant(P=0.027).In terms of postoperative complications,9 patients in the prophylactic resection group and 5 patients

关 键 词：常染色体显性遗传多囊肾病 肾切除术 同种异体肾移植术 围手术期医护 手术后并发症 

分 类 号：R699.2[医药卫生—泌尿科学]