肾移植前经后腹腔镜切除常染色体显性遗传多囊肾的有效性及围手术期安全性分析  

Feasibility and perioperative safety of retroperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney before kindey transplantation

作　　者：吕竟成 侯雨时 郭宇文[1] 张磊[1] 王志鹏[1] 张健[1] 朱一辰[1] Lyu Jingcheng;Hou Yushi;Guo Yuwen;Zhang Lei;Wang Zhipeng;Zhang Jian;Zhu Yichen(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10期680-684,共5页International Journal of Surgery

摘　　要：目的探究肾移植前经后腹腔入路切除常染色体显性遗传多囊肾(ADPKD)的有效性及围手术期安全性。方法采用回顾性研究方法,选取2013年1月—2020年12月于首都医科大学附属北京友谊医院诊断为ADPKD并在肾移植前行后腹腔镜多囊肾切除术的患者共22例。收集患者术前流行病学资料、手术时间、术中出血量、围手术期输血情况、中转开腹率、术后胃肠功能恢复时间、放置引流管时间、术后住院时间、并发症发生率及严重程度等。结果本研究中所有患者平均年龄为(50.95±9.28)岁,术前平均多囊肾最长径为(18.83±2.38)cm。22例患者中,20例为移植做准备而切除多囊肾,另2例因多囊肾囊腔破裂出血而切除多囊肾。所有患者平均手术时间为(191.14±70.46)min,中位术中出血量为100 mL。其中5例患者术中出血量较大,给予术中输血。2例患者因术中粘连严重而中转开放手术。在术后恢复方面,患者平均胃肠功能恢复时间为(2.09±0.61)d,平均放置腹腔引流管时间为(5.32±2.08)d,平均术后住院时间为(7.55±2.34)d。在术后并发症方面,4例患者出现术后切口疼痛、出血等并发症,但均在对症处理后好转。结论对于ADPKD患者,在移植前经后腹腔镜入路可有效切除原位多囊肾。同时,该手术时间短、患者术后恢复快、并发症发生率及严重程度较低,可作为ADPKD患者肾移植前切除原位多囊肾的首选术式。Objective To evaluate the feasibility and perioperative safety of retroperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease(ADPKD)before kidney transplantation.Methods A total of 22 patients with ADPKD who underwent laparoscopic polycystic nephrectomy before kidney transplantation in Beijing Friendship Hospital,Capital Medical University from January 2013 to December 2020 were enrolled in this retrospective study.Preoperative epidemiological data,operation time,intraoperative blood loss,perioperative blood transfusion,conversion rate,postoperative gastrointestinal function recovery time,drainage tube placement time,postoperative hospital stay,incidence and severity of complications were collected.Results The mean age of all patients in this study was(50.95±9.28)years old,and the mean preoperative polycystic kidney diameter was(18.83±2.38)cm.In all patients,20 patients were scheduled for polycystic nephrectomy due to transplantation and 2 patients were done for polycystic renal cyst rupture and hemorrhage.The mean operation time of all patients was(191.14±70.46)min,and the median intraoperative blood loss was 100 mL.Among them,5 patients had large intraoperative blood loss,and were given intraoperative blood transfusion.Two of all patients were converted to open due to severe intraoperative adhesions.In terms of postoperative recovery,the mean recovery time of gastrointestinal function was(2.09±0.61)d,the mean time of abdominal drainage tube placement was(5.32±2.08)d,the mean postoperative hospital stay was(7.55±2.34)d.In terms of postoperative complications,4 patients developed postoperative incision pain,bleeding or other complications,but all improved after symptomatic treatment.Conclusions For patients with ADPKD,original polycystic kidney can be effectively resected by retroperitoneoscopy before transplantation.At the same time,the operation time is short,and patients have quick postoperative recovery,even the incidence and severity of postoperative complications are low.

关 键 词：腹腔镜 肾切除术 围手术期医护 有效性研究 常染色体显性遗传多囊肾病 后腹腔 

分 类 号：R699.2[医药卫生—泌尿科学]