Municipal Clinical Hospital No. 52 of the Moscow Department of Healthcare, Moscow, Russian Federation.
Institute of Urology and Human Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation,
Nephron. 2021;145(2):164-170. doi: 10.1159/000513168. Epub 2021 Feb 5.
In patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage kidney disease, bilateral nephrectomy (BN) is currently performed predominantly via the laparoscopic approach. We analysed the results of BN depending on the approach and preoperative and perioperative factors.
This was a single-centre retrospective study carried out from April 2010 to March 2020, including a total of 142 patients presenting with ADPKD who were treated by BN. Of these, 108 patients meeting the inclusion criteria were selected to analyse the results. We compared therapeutic outcomes depending on the surgical approach (laparotomy or laparoscopy) and the type of the operation (emergent or elective).
Of the 108 eligible patients, 36 (group I) underwent laparoscopic BN and the remaining 72 patients (group II) were subjected to midline laparotomy. Sixty-nine patients underwent elective surgery and 39 endured emergent operations. The most frequent indications (87 patients, 80.6%) for surgical treatment were urinary tract infection and infected cysts. The median length of hospital stay for group I and group II patients amounted to 8 days (IQR: 7.5-9) and 12.5 days (IQR: 9-16.5), respectively (p < 0.001). However, comparing the patients operated on electively, the actual difference in the length of hospital stay was inconsiderable: median 8 days (IQR: 7-9) in group I and 9 days (IQR: 9-11.5) in group II. The median duration of the operation was significantly (p < 0.001) longer in group I amounting to 217.5 min (IQR: 197.5-305) than in group II equalling 115 min (IQR: 107.5-145). The frequency of postoperative complications, lethal outcomes, and blood loss volume did not statistically significantly differ depending on the surgical approach. Only patients operated on emergency underwent releparotomy due to intraoperative large bowel injury. Lethal outcomes (n = 18, 16.7%) after surgery were observed only in emergent patients. Sepsis prior to surgery, systemic inflammation response syndrome (SIRS) with the CRP level above 173 mg/mL, prolonged preoperative antibacterial therapy, and undiagnosed large bowel injury were associated with a lethal outcome after BN.
The results of open and laparoscopic BN in elective surgery were comparable. Emergency operations for infected renal cysts and SIRS were associated with increased incidence of large bowel injury and lethal outcomes.
在常染色体显性遗传性多囊肾病（ADPKD）和终末期肾病患者中，目前主要通过腹腔镜方法进行双侧肾切除术（BN）。我们分析了根据手术方法以及术前和围手术期因素进行 BN 的结果。
这是一项单中心回顾性研究，于 2010 年 4 月至 2020 年 3 月进行，共纳入 142 例 ADPKD 患者，这些患者均接受 BN 治疗。其中，选择了符合纳入标准的 108 例患者进行结果分析。我们比较了根据手术方法（剖腹手术或腹腔镜手术）和手术类型（急诊或择期）的治疗效果。
在 108 例合格患者中，36 例（I 组）接受了腹腔镜 BN，其余 72 例（II 组）接受了中线剖腹手术。69 例患者接受了择期手术，39 例患者接受了急诊手术。手术治疗最常见的指征（87 例，80.6%）是尿路感染和感染性囊肿。I 组和 II 组患者的中位住院时间分别为 8 天（IQR：7.5-9）和 12.5 天（IQR：9-16.5）（p < 0.001）。然而，比较择期手术患者，实际住院时间差异不大：I 组中位数为 8 天（IQR：7-9），II 组中位数为 9 天（IQR：9-11.5）。I 组手术时间明显较长（p < 0.001），为 217.5 分钟（IQR：197.5-305），而 II 组为 115 分钟（IQR：107.5-145）。手术方法与术后并发症、致死结局和失血量均无统计学差异。仅因术中大肠损伤而接受再次剖腹手术的急诊手术患者发生术后并发症。术后仅在急诊患者中观察到 18 例（16.7%）致死结局。术前脓毒症、C 反应蛋白水平高于 173mg/ml 的全身炎症反应综合征（SIRS）、术前抗菌治疗时间延长和未诊断的大肠损伤与 BN 后的致死结局相关。
择期手术中开放和腹腔镜 BN 的结果相当。感染性肾囊肿和 SIRS 的急诊手术与大肠损伤和致死结局发生率增加相关。
