多囊肾病慢性疼痛的手术治疗研究

目的:比较不同手术方式对于缓解多囊肾病引起的慢性疼痛的效果.方法:对1992年1月至2002年11月间在我院进行手术治疗的有疼痛症状的多囊肾患者,利用相对疼痛缓解指数(RPR),比较囊肿穿刺抽吸术、开放去顶减压术、内引流联合去顶减压术和腹腔镜去顶减压术4种手术对于疼痛的缓解效果.结果:4种手术在术后24个月内对于疼痛的缓解无显著性差异;术后36个月穿刺组RPR低于其它3组;术后48个月,内引流组RPR高于其它3组,而穿刺组全部复发;术后60个月,腹腔镜组RPR低于内引流组和开放组.术后72和96个月,内引流组RPR高于开放组.疼痛缓解时间穿刺组短于其它组,其它3组无显著性差异.结论:手术是治疗由多囊肾病慢性疼痛的较好方法,但不同手术各自具有自身的优缺点,仍有待改进.

RESEARCH OF THE SURGICAL MANAGEMENTS OF CHRONIC PAIN IN AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Objective:To compare the effects of different surgical managements on the chronic pain in autosomal dominant polycystic kidney disease(ADPKD).Methods:The effects of different surgery were compared by visual analogue scale(VAS) and relative pain relief(RPR).In a total of 115 patients,10 underwent percutaneous cysts aspiration,49 underwent open decortication,23 underwent intrapelvic drainage combined with decortication,and 33 underwent laparoscopic decortication.Results:There was no significant difference of the RPR in the four groups in the period of 24 months follow-up.36 months after surgery,the group underwent cysts aspiration has a lower RPR than the others.48 months after surgery,the group underwent intrapelvic drainage has the higher RPR than the others,while all the patients underwent aspiration had a recurrence of the pain.60 months after surgery,the group underwent laparoscopic decortication had a lower RPR than the groups underwent open decortication and intrapelvic drainage.72 and 96 months after surgery,the group underwent intrapelvic drainage had a higher RPR than the group underwent open decortication.The group underwent cysts aspiration has a much sooner recurrence of pain than the other groups.Conclusion: Pain in ADPKD was well managed by surgery.Each surgery has its advantage and disadvantage,and the surgeons need to choose them carefully.