1、 常染色体显性遗传性多囊肾病论文：腹腔镜囊肿去顶减压术联合肾脏被膜剥脱术治疗常染色体显性遗传多囊肾的应用【中文摘要】评价腹腔镜囊肿去顶减压术(laparoscopic cyst decompression,LCD)联合肾脏被膜剥脱术治疗常染色体显性遗传性多囊肾病(autosomal dominant polycystic kidney disease,ADPKD)的应用及其临床疗效。方法：对我中心自 2004 年 1 月至 2011 年 1 月同一位医生采用腹腔镜囊肿去顶减压术(LCD)联合肾脏被膜剥脱术治疗的 20 位常染色体显性多囊肾患者(11 男性,9 位女性)进行回顾性研究,对手术时间
2、、术中失血量、术后开始下床活动时间及平均住院天数进行研究,并对手术前后肾功能、肾脏体积、囊肿大小、血压及疼痛程度等多项指标进行对比。将以上患者及各组数据作为实验组。同时,随机选取我中心这位医生自 2004 年 1 月至 2011 年 1 月采用单纯性腹腔镜囊肿去顶减压术治疗的 50 例常染色体显性多囊肾患者(28 男性,22 女性)的术前、术后多项指标进行回顾性研究作为对照组。两组进行比较分析。结果：20 例实验组均获成功,无死亡病例,无术中转开放手术病例,无术后严重并发症发生。手术时间65min194min,平均 10615.4min,术中失血量 20-180m1,平均39ml。开始下床活动
3、时间 1-2d,术后 4-10 d 出院,所有病理结果提示符合多囊肾改变。随访 2-24 个月,平均 16.72.4 个月,术后肾功能改善者 2020；13 例血压升高者术后 2-24 个月收缩压下降 18-30mm Hg;术后 2-24 个月所有患者术侧肾脏体积及最大囊肿体积缩小；术后 2-24 个月术前所有存在腰腹部疼痛的患者患者其腰腹痛较术前减轻。对照组 50 例手术均获成功,无死亡病例,无术中转开放手术病例,无术后严重并发症发生。手术时间 58min-155min,平均8510.7min,术中失血量 10230 ml,平均 27ml。开始下床活动时间 12d,术后 49 d 出院,所有
4、病理结果提示符合多囊肾改变。随访 224 个月,平均 15.33.9 个月,术后肾功能改善者 50/50；38例血压升高者术后 224 个月收缩压下降 1226mm Hg;术后 224个月所有患者术侧肾脏体积及最大囊肿体积缩小；术后 224 个月术前所有有腰腹部疼痛的患者患者其腰腹痛较术前减轻。各项指标P0.05,具有统计学意义。结论：腹腔镜囊肿去顶减压术联合被膜剥脱术治疗常染色体显性多囊肾方法可靠,短期疗效确切,创伤少,术后恢复快,手术安全性高,可有效地减轻术后囊肿再发时对肾脏本身的压迫,从而尽可能的保护残余肾组织的功能。可以在临床上进一步推广应用。【英文摘要】:A retrospectiv
5、e study was undertaken to evaluate the application and efficacy of laparoscopic cyst decompression combined with renal capsule decortication in patients with autosomal dominant polycystic kidney disease(ADPKD).Methods:From January 2004 to January 2011,20 patients (Experimental group,11 males and 9 f
6、emales) with adult polycystic kidney disease were treated with laparoscopic cyst decompression combined with renal capsule decortication and the data were reviewed. Indexes such as mean operating time, loss of blood, postoperative hospital stay, drainage, renal function before and after operation, b
7、lood pressure, and lumbar pain were analyzed with SPSS for statistical test.At the same time, the same indexes of 50 patients (The control group,28 males and 22 females) treated with laparoscopic cyst decompression only between January 2004 and January 2011 were analyzed.Results:In group 1, the oper
8、ations were completed smoothly in all the 20 cases. The operation time was 65-194 min (mean,10615.4 min), and the blood loss was 20-180 ml (mean,39 ml). Patients began out of bed activities in 12 days after operation and were discharged from hospital at 410 days. All the pathological findings were i
9、n accordance with changes of ploycystic kidney. Follow up examinations were carried out for 224 months (mean,16.72.4 months). Renal function and back pain was relived in all cases. In 13 patients with a high blood pressure, the systolic pressure was decreased by 1830 mm Hg. The size of the kidneys a
10、nd the largest cysts which were treated became smaller. In group 2, the operations were completed smoothly in all the 50 cases. The operation time was 658155 min (mean,8510.7 min), and the blood loss was 10230 ml (mean,27 ml). Patients began out of bed activities in 1-2 days after operation and were
11、 discharged from hospital at 49 days. All the pathological findings were in accordance with changes of ploycystic kidney. Follow up examinations were carried out for 224 months (mean, 15.33.9 months). Renal function and back pain was relived in all cases. In 38 patients with a high blood pressure, t
12、he systolic pressure was decreased by 1226 mm Hg. The size of the kidneys and the largest cysts which were treated became smaller, too.Conclusions:Treatment of aparoscopic cyst decompression combined with renal capsule decorticationin is a safe and effective method in thetreatment of ADPKD, being wo
13、rthy of clinical recommendation【关键词】常染色体显性遗传性多囊肾病 腹腔镜囊肿去顶减压术 肾脏被膜剥脱术【英文关键词】Autosomal dominant polycystic kidney disease (ADPKD) Laparoscopic cyst decompression (LCD) Renal capsule decortication【目录】腹腔镜囊肿去顶减压术联合肾脏被膜剥脱术治疗常染色体显性遗传多囊肾的应用 中文摘要 6-8 ABSTRACT 8-9 符号说明 10-11 前言 11-25 1.材料和方法 12-15 2.结果 15-20 3.讨论 20-22 4.结论 22-23 参考文献 23-25 综述 25-42 参考文献 38-42 致谢 42-43 学位论文评阅及答辩情况表 43
