成人多囊肾病囊肿去顶减压术合理性探讨

Clinical effect and rationality of cyst decompression for adult polycystic kidney disease patients

关键词:  多囊肾  去顶减压术  肾功能

Key words:  adult polycystic kidney disease  cyst decompression  renal function

摘要:

［目的］结合临床从理论上分析成人多囊肾病（APKD）囊肿去顶减压术（CD）的价值，探讨APKD最佳手术时机。［方法］收集大连医科大学第一临床学院1990年以来行囊肿去顶减压术的72例，根据是否有肾功能改变分成两组：肾功能正常组 30例（单侧18例、双侧12例，共42个肾脏）；肾功能不全组42例（单侧29例、双侧13例，共55个肾脏）。分析其术后3、6个月和1、3、5年5个时间点的肾功能、腰痛和高血压变化情况，探讨CD术的临床应用价值及其最佳手术时机。［结果］肾功能正常组：术后1年内肾功能均保持正常，无腰痛、高血压出现。术后18个月开始出现肾功能不全病例，3、5年发生率分别为33.3%(10/30)、70%(21/30)；15个月开始出现腰痛病例，3、5年发生率分别为45.2%(19/42)、83.3%(35/42)；16个月开始出现高血压病例，3、5年发生率分别为36.7%(11/30)、70%(21/30)。肾功能不全组：术后肾功能均有不同程度改善；腰痛缓解率100%，血压下降率88%（22/25），5个时间点各临床指标的变化情况：（1）肾功能恢复至术前水平的发生率分别为4.8%(2/42)、11.9(5/42)%、26.2%(11/42)、100%、和100%。（2）腰痛复发率分别为9.1%（5/55），41.9%（23/55），70.9%（39/55），100%和100%。（3）高血压复发率分别为4.5%（1/22），18.2%（4/22），45.5%（10/22），72.7%（16/22）和95.5%（21/22）。［结论］CD术对保护肾功能、解除腰痛和降血压效果明显，最佳手术时机是在肾功能出现异常前。

Abstract:

［Objective］To discuss the clinical effect and the optimal timing of the cyst decompression (CD) for adult polycystic kidney disease (APKD) patients.［Methods］All 72 cases of cyst decompression of APKD were analysed. They were divided into two groups according to their renal function, namely group 1 (normal renal function) and group 2 (renal functional impairment). Group 1 was composed of 30 cases (18 with unilateral operation, 12 with bilateral), accordingly, 42 cases ( 29 with unilateral, 13 with bilateral) in group 2. Flank pain, blood pressure and renal function were monitored in the two groups in 3 months, 6 months, 1 year, 3 years and 5 years after operation respectively.［Results］One year after CD, the renal function remained normal, and with no flank pain and hypertension in Group 1. The incidences of renal functional impairment in 3 years and 5 years were 33.3% (10/30) and 70.0% (21/30) respectively. Flank pain occurred after 15 months. The incidences in 3 years and 5 years were 45.2%(19/42) and 83.3%（35/43）respectively. Hypertension occurred after 16 months. The incidences of 3 years and 5 years were 36.7% (11/30) and 70.0% (21/30) respectively. The renal function improved more or less after CD in Group 2. Flank pain relieved in all cases, and hypertension improved in 88% (22/25) cases. But the incidence of the progression of renal function impairment to the level of pre-operation were 4.8% (2/42) at 3 months, 11.9% (5/42) at 6 months, 26.2%(11/42) at 1 years, and 100% at 3 years and 5 years. The flank pain recurrence were 9.1% (5/55) at 3 months, 41.9%(23/55) at 6 months, 70.9% (39/55) at 1 year, and 100% at 3 years and 5 years. The recurrence of hypertension were 4.5% (1/22) at 3 months, 18.2% (4/22) at 6 months, 45.5% (10/22) at 1 year, 72.7% (16/22) at 3 years and 95.5%(21/22) at 5 years.［Conclusions］Cyst decompression is valuable for relief of flank pain and hypertension in APKD patients within one year after operation. The optimal timing for the operation is before the development of renal functional impairment.