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终末期肾病接受腹膜透析的结直肠癌患者的围手术期管理及手术结局

Perioperative Management and Surgical Outcomes of Colorectal Cancer Patients Undergoing Peritoneal Dialysis for End-Stage Kidney Disease.

作者信息

Kouno Nobuji, Takahashi Ryo, Furuya Takumi, Fujikawa Takahisa

机构信息

Surgery, Kokura Memorial Hospital, Kitakyushu, JPN.

出版信息

Cureus. 2022 Jul 9;14(7):e26708. doi: 10.7759/cureus.26708. eCollection 2022 Jul.

Abstract

INTRODUCTION

Despite the fact that the number of peritoneal dialysis (PD) patients is increasing, there is little evidence on the surgical outcomes of PD patients who have colorectal cancer surgery, and there is no consensus on the safety and practicality of continuing PD.

METHODS

We retrospectively evaluated the short- and long-term results, as well as the feasibility of continuing PD, in eight patients with PD who had colorectal cancer surgery at our institution between January 2010 and January 2021.

RESULTS

The scheduled open-fashioned resection was performed in one patient, whereas the other seven surgeries were all conducted laparoscopically, with no intraoperative conversion to laparotomy necessary. Except for one patient with a history of recurring PD-related peritonitis, the PD catheter was kept in seven of the eight cases. Five of the seven patients continuing PD underwent temporary postoperative hemodialysis. At a median of 24.5 months of postoperative monitoring, no infectious complications were observed, six cases continued PD, and no recurrence of colorectal cancer was observed in all cases.

CONCLUSIONS

Routine curative-intent colorectal cancer surgery with the preservation of the PD catheter is possible and safe in individuals receiving PD. This patient population's short- and long-term oncological results are comparable to general surgical outcomes of those without chronic kidney disease. PD can be maintained for a long period of time following major colorectal cancer surgery.

摘要

引言

尽管腹膜透析(PD)患者数量在增加,但关于接受结直肠癌手术的PD患者的手术结局的证据很少,并且对于继续进行PD的安全性和实用性尚无共识。

方法

我们回顾性评估了2010年1月至2021年1月期间在我们机构接受结直肠癌手术的8例PD患者的短期和长期结果以及继续进行PD的可行性。

结果

1例患者进行了预定的开放式切除术,而其他7例手术均通过腹腔镜进行,无需术中转为开腹手术。除1例有复发性PD相关腹膜炎病史的患者外,8例中有7例保留了PD导管。继续进行PD的7例患者中有5例术后进行了临时血液透析。在术后中位24.5个月的监测中,未观察到感染并发症,6例继续进行PD,所有病例均未观察到结直肠癌复发。

结论

对于接受PD的个体,保留PD导管进行常规的根治性结直肠癌手术是可行且安全的。该患者群体的短期和长期肿瘤学结果与无慢性肾病患者的普通外科手术结局相当。在结直肠癌大手术后,PD可以长期维持。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3fc8/9360629/72bec34061c7/cureus-0014-00000026708-i01.jpg

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