去肾脏交感神经术联合肾被膜剥脱术治疗多囊肾合并难治性高血压的疗效  

Observation of the curative effect of sympathetic nephrectomy combined with renal capsule stripping in the treatment of polycystic kidney disease with refractory hypertension

作　　者：苏顺业[1] 梁利芹[2] 朱岩 乔梁[1] 周洁璐[3] 刘鲁东[1] 缪伟[4] 卢洪凯[1] 陈志鹏 高远[1] Su Shunye;Liang Liqin;Zhu Yan;Qiao Liang;Zhou Jielu;Liu Ludong;Miao Wei;Lu Hongkai;Chen Zhipeng;Gao Yuan(Department of Urology,Weifang People′s Hospital,Weifang 261041,China;Department of Outpatient,Weifang People′s Hospital,Weifang 261041,China;Department of Anesthesiology,Weifang People′s Hospital,Weifang 261041,China;Department of Ultrasound,Weifang People′s Hospital,Weifang 261041,China)

机构地区：[1]潍坊市人民医院泌尿外科,潍坊261041 [2]潍坊市人民医院门诊部,潍坊261041 [3]潍坊市人民医院麻醉科,潍坊261041 [4]潍坊市人民医院超声科,潍坊261041

出　　处：《国际泌尿系统杂志》2023年第3期500-505,共6页International Journal of Urology and Nephrology

摘　　要：目的探讨去肾脏交感神经术联合肾被膜剥脱术治疗多囊肾合并难治性高血压的疗效。方法回顾性分析2013年3月至2019年1月在本院收治的57例多囊肾合并难治性高血压患者的临床资料。根据手术方式的不同分为对照组(18例,单纯采用后腹腔镜下多囊肾去顶减压术)、剥脱组(13例,采用后腹腔镜下多囊肾去顶减压术联合肾被膜剥脱术)、去神经组(14例,采用后腹腔镜下多囊肾去顶减压术联合去肾脏交感神经术)和综合组(12例,采用后腹腔镜下多囊肾去顶减压术联合肾被膜剥脱术及去肾脏交感神经术)。收集患者的手术时间、术中失血量及术后住院时间,分析术前和术后1、6、12、24个月的肾功能、肾脏体积、囊肿大小、血压及疼痛程度等多项指标。结果剥脱组、去神经组、综合组在术后1、6、12及24个月的收缩压水平较术前均明显下降(均P<0.05)。与对照组比较,剥脱组、去神经组、综合组的收缩压水平下降,差异均有统计学意义(均P<0.05),与剥脱组、去神经组比较,综合组的收缩压水平下降更明显,差异均有统计学意义(均P<0.05)。四组患者术后的肾功能均未进行性升高,术侧肾脏体积及最大囊肿体积均有明显缩小(均P<0.05)。四组术后1、6、12及24个月的肾小球滤过率(GFR)较术前改善,差异均有统计学意义(均P<0.05)。与对照组、去神经组比较,剥脱组、综合组的GFR明显改善,差异均有统计学意义(均P<0.05)。去神经组、综合组术后6、12、24个月的左心室重量指数(LVMI)较术前及术后1个月降低,LVEF则升高,差异均有统计学意义(均P<0.01)。对照组患者中有1例随访2个月后失访,另1例在随访4个月后失访,其余各组患者均未失访。术后患者均未发生动静脉瘘、假性动脉瘤、肾动脉狭窄等并发症。综合组的手术时间长于较其他三组,而术中失血量高于其他三组,剥脱组与综合组的住院时间多于�Objective To investigate the efficacy of renal sympathetic denervation combined with renal capsule stripping in the treatment of polycystic kidney disease with refractory hypertension.Methods The clinical data of 57 patients with polycystic kidney disease and refractory hypertension admitted to our hospital from March 2013 to January 2019 were retrospectively analyzed.According to the different surgical methods,they were divided into control group(18 cases),exfoliation group(13 cases),denervation group(14 cases)and the comprehensive group(12 cases).The operation time,intraoperative blood loss and postoperative hospital stay were collected,and the renal function,renal volume,cyst size,blood pressure and pain degree were analyzed before operation and 1,6,12,24 months after operation.Results The systolic blood pressure in denervated group,denervated group and combined group decreased significantly at 1,6,12 and 24 months after operation(all P<0.05).Compared with the control group,the systolic blood pressure levels of the denervated group,denervated group and combined group decreased,and the differences were statistically significant(all P<0.05).Compared with the denervated group and denervated group,the systolic blood pressure levels of the combined group decreased more significantly,and the differences were statistically significant(all P<0.05).There was no progressive increase in renal function after operation,and the volume of the operated kidney and the largest cyst were significantly reduced in the four groups(all P<0.05).The GFR of the four groups at 1,6,12 and 24 months after operation was improved compared with that before operation,and the differences were statistically significant(all P<0.05).Compared with the control group and denervated group,the GFR of denervated group and combined group improved significantly,and the differences were statistically significant(all P<0.05).Left ventricular mass index(LVMI)in denervation group and cpmprehensive group at 6,12 and 24 months after operation were lower than t

关 键 词：多囊肾疾病 高血压 去肾脏交感神经术 肾脏被膜剥脱术 

分 类 号：R699.2[医药卫生—泌尿科学] R544.1[医药卫生—外科学]