| 任宇峰,王元宇,牟一平.慢性肾脏病IV-V期患者微创胃肠胰肿瘤切除术围手术期管理体会[J].浙江中西医结合杂志,2023,33(5): |
| 慢性肾脏病IV-V期患者微创胃肠胰肿瘤切除术围手术期管理体会 |
| Perioperative management of complete laparoscopic gastrointestinal pancreatic tumor resection in patients with stage IV-V chronic kidney disease |
| 投稿时间：2023-02-02 修订日期：2023-03-28 |
| DOI： |
| 中文关键词: 慢性肾脏病 胃癌 直肠癌 胰腺癌 微创手术 围手术期 |
| 英文关键词:Chronic kidney disease Gastric cancer rectal cancer Pancreatic cancer Total laparoscopic perioperative |
| 基金项目:国家卫生健康委科学研究基金-浙江省卫生健康重大科技计划(项目号：WKJ-ZJ-2201) |
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| 中文摘要: |
| 目的：探讨慢性肾脏病IV-V期患者微创胃肠胰肿瘤切除术围手术期治疗的措施及价值。方法：收集2019年6月-2021年12月我们收治8例IV-V期慢性肾脏病胃肠胰肿瘤患者，在微创方式下行肿瘤根治术的临床资料。结果：本组8例择期手术患者，无死亡病例，无心力衰竭、心房颤动、呼吸衰竭、心肌梗死、脑梗死肺部感染、肺梗死、深静脉血栓形成、切口感染、腹腔感染、腹腔出血、消化道出血、吻合口漏、胆漏和胰漏等并发症。根据外科并发症的Clavien-Dindo分级，I级2例，无II-V级并发症；胰十二指肠切除患者术后2周出现胃肠吻合口出血，内镜下止血治疗；胰体尾切除患者术后出现胰漏，行超声引导下穿刺置管引流。7例康复出院，1例入院前血透患者术后12天转肾内科继续治疗肾病。术后住院8-24天。结论：对于慢性肾脏病IV-V期患者行微创胃肠胰肿瘤切除术，加强围手术期治疗，可以降低患者的并发症发生率和病死率。但本研究病例数较少，仍需更大样本的数据支持该结论。 |
| 英文摘要: |
| Objective To investigate the perioperative treatment and value of total laparoscopic resection of gastric, rectal and pancreatic tumor in patients with IV-V chronic kidney disease. Methods We retrospectively analyzed the clinical data and follow-up data of 8 patients with stage IV-V chronic kidney disease (CKD) who were accepted total laparoscopic resection of gastric, rectal and pancreatic neoplasms. Results Six patients were undergoing elective surgery. There was no death, heart failure, atrial fibrillation, respiratory failure, myocardial infarction, cerebral infarction, pulmonary infection, pulmonary infarction, deep vein thrombosis, incision infection, abdominal infection, abdominal bleeding, gastrointestinal bleeding, anastomotic leakage, biliary leakage, and pancreatic leakage and other complications. According to the Clavien-Dindo classification of surgical complications, there were 3 grade I cases and no grade II-V complications, the patients with pancreaticoduodenectomy, gastrointestinal anastomotic bleeding occurred 2 weeks after surgery, and endoscopic hemostasis was performed. Patients with pancreatic leakage and local abdominal infection after distal pancreatectomy were treated with ultrasound-guided puncture and catheter drainage. Five patients recovered and were discharged from hospital, and one patient with hemodialysis before admission was transferred to the Department of Nephrology for continued treatment of nephropathy in 12 days after surgery. The postoperative hospital stay was 8-24 days. Conclusions For patients with stage IV-V chronic kidney disease, total laparoscopic gastrectomy and enhanced perioperative treatment can reduce the incidence of complications and mortality. However, due to the small number of cases in this study, data from a larger sample is still needed. |
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