多囊肾病慢性疼痛的手术治疗研究

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

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。

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.