目的 探讨维持性腹膜透析患者因伴随疾病需要手术治疗的可行性及围手术期的处理。 方法 选择2006年3月～2021年5月北京大学人民医院所有腹膜透析患者，记录全部手术，进行回顾性研究。调查手术的一般资料，对比手术前后血红蛋白，电解质，肾功能，血压等，记录有无手术并发症，探讨腹膜透析患者围手术期的管理及透析方案。 结果 513例维持性腹膜透析患者中，72例(占透析患者的 14.0%)因各种伴随疾病需要手术96例次。最终71例次手术纳入分析，涉及到11个不同科室。患者手术后较手术前血红蛋白(t=3.436,P =0.001)、血清白蛋白(t=3.362,P =0.002)、二氧化碳结合力(t=4.205,P＜0.001)降低，但均处于控制目标范围内。手术后收缩压(t=-0.303,P=0.763)、舒张压(t=1.494,P =0.140)、血钾(t=-1.352,P =0.183)较手术前无明显变化。与局部麻醉组、椎管内麻醉组相比，全身麻醉的患者有更高的概率(58.3%)在围手术期转为持续肾替代治疗或血液透析。18例次手术在围手术期常规应用抗生素，25例次手术操作使用碘造影剂。共发生手术并发症2例次，均为手术后腹膜炎。手术后1周内死亡1例。余患者预后良好。 结论 维持性腹膜透析患者手术及操作的风险较高，但经过恰当的围手术期处理，多可耐受手术。加强围手术期的管理尤其是透析方案的调整有助于患者安全度过围手术期。
Objective The purpose of this study was to explore the feasibility and the perioperative management of surgical treatment due to concomitant diseases in patients with maintenance peritoneal dialysis (MPD). Methods All peritoneal dialysis patients treated in Peking University People's Hospital from March 2006 to May 2021 were enrolled in this study, and the surgical operation records were reviewed for retrospective study. General information of the operation, levels of hemoglobin, electrolyte, renal function, blood pressure and others before and after the operation for 1-3 days, and surgical complications were recruited. Perioperative management and dialysis program were then explored in the MPD patients. Results In the 513 MPD patients, 72 (14.0%) patients required 96 operations for various concomitant diseases, and 71 operations involved in 11 departments were analyzed in this study. Hemoglobin (100.15±14.95 vs. 106.15±14.95 g/L, t=3.436, P=0.001), serum albumin (32.45±5.14 vs. 34.99±5.14, t=3.362, P=0.002) and carbon dioxide binding capacity (25.30±3.66 vs. 27.04±2.76, t=4.205, P＜0.001) decreased but still within the target ranges after the operations as compared with those before the operations. Blood pressure and serum potassium had no changes after the operations. Patients used general anesthesia had a higher probability (58.3%) of switching to continuous renal replacement therapy (CRRT) or hemodialysis during perioperative period than those used local anesthesia and intra-spinal anesthesia. Antibiotics were routinely used in 18 operations, and iodine contrast agent was used in 25 operations. Postoperative peritonitis occurred in 2 cases. The prognosis was better in most cases except that one patient died within one week after the operation. Conclusion There are higher risks in MPD patients undertaking surgical operation. However, most patients tolerate the surgery if perioperative management is appropriately arranged. Management of perioperative period, especially the adjustment of dialysis program, must be emphasized to help patients safely go through the perioperative period.
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