腹腔镜根治性膀胱切除术后急性肾损伤的防治

Prevention and treatment of acute kidney injury after laparoscopic radical cystectomy

目的:提高对腹腔镜根治性膀胱切除(laparoscopic radical cystectomy,LRC)术后并发急性肾损伤(acute kidney injure,AKI)的认识和防治水平。方法:通过病例分析及文献研究,探讨LRC术后AKI患者的危险因素及预防治疗措施。结果:2例患者行LRC术后1周并发3级AKI。经过针对原发诱因及连续肾脏替代(continuous renal replacement therapy,CRRT)治疗,约3~4周后肌酐稳定,发展至轻中度慢性肾脏病。结论:LRC术后AKI发生是综合因素的结果。LRC术后发生AKI高危风险因素包括高龄、复杂手术、长时间手术、基础疾病多等,其中女性、高血压、既往慢性肾脏病史、IV级以上的ASA麻醉分级、既往手术史均为腹部手术后AKI发生的独立危险因素。围手术期针对腹腔高压(intra-abdominal hypertension,IAH)、感染等高危因素的积极主动处理有利于预防AKI的发生。推荐早期CRRT治疗,能取得较好预后。

Objective：To raise awareness of the risk factors,pathogenesis,diagnosis and treatment of acute kidney injury（AKI）after laparoscopic radical cystectomy（LRC）.Method：Through literature review and case analysis,the high risk factors,prevention and treatment of AKI after LRC were discussed.Result：AKI（Grade3）occurred in two patients who underwent LRC after one week.With the etiological treatment and continuous renal replacement therapy（CRRT）,the serum creatinine decreased three to four weeks later.The two patients finally developed to mild and moderate chronic kidney disease（CKD）.Conclusion：AKI after LRC resulted from variety of high risk factors,including elderly patients,complicated operation,long time operation,multiple underlying diseases.Female,high blood pressure,CKD history and ASA Ⅳ are independent risk factors.Better outcomes could be achieved by perioperative active treatment for high risk factors,such as management for intra-abdominal hypertension（IAH）and infection.Early CRRT is recommended to improve prognosis.