成人型常染色体显性遗传性多囊肾病的腹腔镜治疗体会(附32例报告)

Laparoscopic renal cyst decortication in the treatment of adult autosomal dominant polycystic kidney disease:with a report of 32 cases

目的：探讨为成人型常染色体显性遗传性多囊肾病患者行腹腔镜肾囊肿去顶减压术的临床疗效。方法：回顾分析2006年6月至2013年1月为32例成人型常染色体显性遗传性多囊肾病患者行腹腔镜肾囊肿去顶减压术的临床资料，观察其手术方式、手术时间、术中出血量、合并症的术后改善情况。结果：32例手术均顺利完成，其中21例采用经腹膜后入路，11例采用经腹腔入路。28例处理双侧病变，4例处理单侧。32例患者随访3—82个月，平均（13．8±4．2）个月，临床症状得到不同程度的缓解，14例高血压患者，血压得到不同程度的控制；9例肾功能不全患者，术后肾功能有不同程度改善。结论：成人常染色体显性遗传性多囊肾病行腹腔镜肾囊肿去顶减压术应尽量采用经腹膜后入路，术中可一次处理双侧病变，具有安全、并发症少、疗效确切等优点。

Objective： To evaluate the clinical efficacy of laparoscopic renal cyst decortication in the treatment of adult autoso- mal dominant polycystic kidney disease. Methods： A retrospective analysis was made on the clinical data of 32 patients who suffered from adult autosomal dominant polycystic kidney disease and were treated with laparoscopic renal cyst decortication from Jan. 2006 to Jan. 2013. The surgical approach, operation time, intraoperative blood loss, and the improvement of postoperative co-morbidities were ob- served. Results ：All 32 patients were treated successfully and followed up from 3 to 82 months, with the average of （13.8 ± 4.2 ） months. The retroperitoneal approach was used in 21 cases, the intraperitoneal approach was used in 11 cases. 28 cases of bilateral kidney and 4 cases of unilateral kidney were operated. There were no severe complications. The symptoms, blood pressure （n = 14 ） and the renal function （ n = 9 ） were improved. Conclusions： Laparoscopic renal cyst decortication can treat bilateral kidney at the same time for patients with adult autosomal dominant polycystic kidney disease,is safe with definite effect and few complications. In this procedure, retroperitoneal approach should be used.