67例慢性肾功能不全患者行经腹全子宫切除术的临床分析

Clinical Analysis of Total Abdominal Hysterectomy in 67 Patients with Chronic Renal Insufficiency

目的 探讨慢性肾功能不全(CRI)患者行经腹全子宫切除术的安全性及可行性。方法 回顾性分析67例行经腹全子宫切除术的CRI患者的临床资料,以同期患相同或相似疾病行相同手术但肾功能正常的30例患者作为对照组,比较组间差异,进行统计学分析。结果 在手术时间、术中出血量、术后48 h引流量等方面,慢性肾脏病(CKD)5期组高于其他3组,差异有统计学意义(P<0.05)。在术后并发症方面,CKD5期组发生率高于对照组和CKD3期组,差异有统计学意义(P<0.001)。结论 对于未进展到尿毒症期的CRI患者,围术期在积极治疗原发病、纠正贫血等对症治疗的基础上,实施经腹全子宫切除术是安全可行的;对于已进展到尿毒症期的患者,手术风险相对较大,围术期除积极治疗原发病,控制现有并发症,做好防治相关并发症的准备外,应常规透析,待病情控制平稳后,再行手术。

Objective To examine the safety and feasibility of total abdominal hysterectomy in patients with chronic renal insufficiency.Methods This was a retrospective analysis using the clinical data of 67 patients with chronic kidney disease(CKD)undergoing total abdominal hysterectomy.The control group included 30 patients with normal renal function and the same or similar diseases,requiring hysterectomy.Comparative statistical analysis of clinical data was performed.Results The operative time,intraoperative blood loss,amount of peritoneal drainage 48 h after surgery,and other parameters were greater in the CKD5 group than in the other CKD groups.The difference was statistically significant(P<0.05).The incidence rate of postoperative complications was higher in the CKD5 group than in the control and CKD3 groups.The difference was statistically significant(P<0.001).Conclusion In patients without uremia,on the basis of active treatment of the primary disease,correction of anemia,and other symptoms in the perioperative period,it is safe and feasible to perform total abdominal hysterectomy.However,in patients with uremia,the risk is relatively high.In addition to active treatment of primary disease,control of existing complications,and prevention and control of perioperative complications,routine dialysis is necessary.The operation should be performed when the patient is stable.