Yu Jiang, Li Bin, Xiang Yu-Zhu, Qi Tai-Guo, Jin Xun-Bo, Xiong Hui
Minimally Invasive Urology Center, Shandong Provincial Hospital Affiliated to Shandong University Medical School, Shandong University, Jinan, China.
Medicine (Baltimore). 2018 Jul;97(27):e11445. doi: 10.1097/MD.0000000000011445.
To investigate the best surgical occasion of laparoscopic cyst decortications (LCDs) in patients with autosomal dominant polycystic kidney disease (ADPKD), in accordance with the renal volume (RV). We retrospectively analyzed 135 (65 male and 70 female) patients with ADPKD who underwent LCD between June 2011 and October 2015. Patients were divided into 4 groups according to the volume of the operated kidney measured from computed tomography scans: group A (28 patients, RV < 500 mL), group B (63 patients, RV = 500-1000 mL), group C (30 patients, RV = 1000-1500 mL), and group D (14 patients, RV > 1500 mL). We studied postoperative indicators at least 1-year follow-up. For each RV group, therapeutic responses of LCD in these patients with ADPKD were assessed by improvement of clinical parameters and manifestations. A significant glomerular filtration rate (GFR) improvement was found in RV group B (31.8 ± 11.1 mL/min; final GFR 36.9 ± 12.7 mL/min; P < 0.01), and RV group C (21.1 ± 8.7 mL/min; final GFR 27.4 ± 9.2 mL/min; P < 0.01). RV group C had much higher GFR improvements than did RV group B (P < 0.01). In addition, refractory pain in patients of RV groups B, C, and D was much relieved by LCD treatment. Compared with other RV groups, blood pressures in patients with ADPKD of RV group D were also improved (P < 0.01). Our study indicates that RV could be used to evaluate LCD clinical outcomes in patients with ADPKD. The results of LCD for patients with ADPKD with RV between 500 and 1500 mL were encouraging, especially with regards to renal function improvement and pain relief. Therefore, RV may become a useful marker to predict the timing of LCD surgery in patients with ADPKD.
为了根据肾体积（RV）研究常染色体显性多囊肾病（ADPKD）患者行腹腔镜囊肿去顶减压术（LCD）的最佳手术时机。我们回顾性分析了2011年6月至2015年10月期间接受LCD的135例（65例男性和70例女性）ADPKD患者。根据计算机断层扫描测量的患肾体积将患者分为4组：A组（28例患者，RV＜500 mL），B组（63例患者，RV = 500 - 1000 mL），C组（30例患者，RV = 1000 - 1500 mL），D组（14例患者，RV＞1500 mL）。我们对至少1年的随访术后指标进行了研究。对于每个RV组，通过临床参数和表现的改善来评估这些ADPKD患者LCD的治疗反应。B组RV（31.8±11.1 mL/min；最终GFR 36.9±12.7 mL/min；P＜0.01）和C组RV（21.1±8.7 mL/min；最终GFR 27.4±9.2 mL/min；P＜0.01）的肾小球滤过率（GFR）有显著改善。C组RV的GFR改善比B组RV高得多（P＜0.01）。此外，LCD治疗使B、C和D组RV患者的顽固性疼痛得到了很大缓解。与其他RV组相比，D组RV的ADPKD患者血压也有所改善（P＜0.01）。我们的研究表明，RV可用于评估ADPKD患者LCD的临床结果。RV在500至1500 mL之间的ADPKD患者LCD结果令人鼓舞，尤其是在肾功能改善和疼痛缓解方面。因此，RV可能成为预测ADPKD患者LCD手术时机的有用标志物。
