肾脏体积对常染色体显性遗传性多囊肾患者手术时机选择的影响

目的 探讨依据肾脏体积为标准，对多囊肾患者行腹腔镜多囊肾去顶减压术的手术时机进行选择，以期指导临床手术开展。方法 选取2004年6月至2009年10月行单侧腹腔镜多囊肾去顶减压术的多囊肾患者251例，回顾分析患者术侧肾脏术前术后肾脏体积。根据肾脏体积分为4个组：A组：＜500mL；B组: 500～1000mL；C组：1000～1500mL；D组：＞1500mL，同时采用双肾核素显像(ECT)测量患者双肾肾小球滤过率(GFR)，对比观察４组患者术侧术前及术后6、12个月GFR提升的幅度。结果 A、D组术侧肾脏术前及术后6、12个月GFR的提升差异无统计学意义(P>0.05)；B、C组提升差异有统计学意义(P<0.01), 其中B组GFR提升优于C组(P<0.05); B、C、D 3组术前、术后腰痛、腹胀等情况改善差异有统计学意义(P＜0.01)；高血压术前、术后的变化，A、B、C 3组差异无统计学意义(P>0.05)，D组差异有统计学意义(P<0.01)。结论 对于行腹腔镜多囊肾去顶减压术多囊肾患者，肾脏体积在500～1500mL时手术效果最佳，同时GFR提升最明显；肾脏体积＜500mL时，可暂时不考虑手术治疗；肾脏体积＞1500mL时，手术对肾脏功能恢复作用有限，但对于缓解腹部压迫、疼痛，改善高血压等并发症效果明显。

Effect of the renal volume on surgical occasion for patients with autosomal dominant polycystic kidney disease

Objective To investigate surgical occasion of laparoscopic cyst decortication (LCD) in patients with autosomal dominant polycystic kidney disease(ADPKD), in accordance with the renal volume. Methods The renal volume data from 251 consecutive patients with ADPKD who underwent LCD from June 2004 to October 2009 were retrospectively analyzed. All patients were divided into 4 groups according to the renal volume: group A, <500mL, group B, 500-1000mL, group C, 1000-1500mL and group D, >1500mL. ECT was applied to detect bilateral glomerular filtration rate(GFR) to make a comparison before and 6 and 12 months after surgery. Results No visible changes were found in GFR before and after LCD in groups A and D(P>0.05), while an increase in GFR was found in groups B and C(P<0.01), and the increase in group B was more prominent than in group C(P<0.05). Patients in group B,C and D were relieved backache and abdominal distension after surgery while a remarkable improvement on hypertension was achieved in group D(P<0.01). Conclusions Among patients with ADPKD undergoing LCD, the most favorable outcome and GFR improvement are found in those with a renal volume ranging from 500 to 1500mL. Surgery is temporarily dismissed for patients with a renal volume <500mL. LCD has a limited impact on recovery of renal function in patients with renal volume>1500mL while a dramatic effect on relief of complications such as abdominal oppression, pains and hypertension.