终末期肾病患者腹腔镜胆囊切除术的安全性评估

Safety evaluation of laparoscopic cholecystectomy in patients with end-stage renal diseases

目的探讨终末期肾病（end-stage renal disease，ESRD）合并胆囊结石的患者进行腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）的围手术期安全性。方法回顾性分析1994年5月～2005年5月41例ESRD合并胆囊结石患者（ESRD组）进行LC的临床资料，并与随意抽取的同期非ESRD 200例LC（非ESRD组）进行比较。结果ESRD组患者的年龄（49．8±11.9岁）明显大于非ESRD组（44．2±12.3岁）（t=2．655，P=0．008），两组血红蛋白（76．3±11．7g／L，120.1±8.4g/L）、血小板计数[（141±36）×10^9／L，（183±51）×10^9／L]均有显著差异（t=22．905，6．226；P〈0．001），ESRD组术前并发心肺疾病的比例（97．6％，40／41）远高于非ESRD组（21．5％，43／200）（χ^2=31.886，P〈0．001），有腹部手术史的比例（24.4％，10／41）也高于非ESRD组（11.5％，23／200）（χ^2=4．784，P=0.043）。但两组手术时间、术中出血量、中转开腹手术率、并发症发生率和肛门恢复排气时间均无显著差异（P=0.659，0．325，0.998，0．430，0.498）。结论ESRD合并胆囊结石的患者进行LC是安全可行的，应注重围手术期处理。

Objective To evaluate the perioperative safety of laparoseopie eholeeysteetomy （LC） in patients with gallstones complicated with end-stage renal disease （ESRD）. Methods Clinical data of 41 patients with gallstones accompanying ESRD treated with LC （ESRD Group） between May 1994 and May 2005 were analyzed retrospectively. Another 200 patients without ESRD （non-ESRD Group） receiving LC during the same period were randomly selected for comparison. Results The patients in the ESRD Group were older than those in the non-ESRD Group （49.8 ±11.9 years vs 44.2±12.3 years; t = 2.655, P = 0.008）. There were significant differences between the ESRD Group and the non-ESRD Group in hemoglobin levels （76.3±11.7 g/L vs 120.1±8.4 g/L） and platelet count [（141±36）×10^9/L vs （183±51）×10^9/L）] （t = 22.905 and 6.226; P〈0.001）. The proportion of patients with complicated cardiac or pulmonary diseases before operations in the ESRD Group （97.6%, 40/41） was much higher than that in the non-ESRD Group （21.5%, 43/200） （χ^2 = 31.886, P 〈 0.001）. The proportion of patients with previous abdominal operation history was higher in the ESRD Group （24.4%, 10/41） than in the non-ESRD Group （11.5%, 23/200） （χ^2 = 4.784, P = 0.043）. No significant differences were seen in operative time, intraoperative blood loss, conversion rate, postoperative complications, and time to first passage of flatus between the two groups （P = 0.659, 0.325, 0.998, 0.430, 0.498, respectively）. Conclusions LC is a feasible and safe procedure for patients with ESRD. And appropriate perioperative management should be emphasized in these patients.