目的 探讨维持性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1月～2007年12月期间北京大学人民医院肾内科维持性血液透析和腹膜透析的患者共175例，进行回顾性研究。调查其接受手术的一般资料，对比其手术前后的血红蛋白、电解质、肾功能、血压等，记录有无手术并发症，探讨围手术期的处理及透析方案。结果 175例维持性透析患者中18例因伴随疾病需手术治疗，占透析患者的10.28%。13例患者接受各科手术17例次。术前血红蛋白(97.35±25.18)g/L，手术前后电解质、肾功能、血压差异均无统计学意义。2例患者出现手术并发症，分别为低血压、呼吸衰竭。1例患者死亡。术后根据手术和病情调整透析方案，分别选择连续性肾脏替代治疗、无肝素血液透析、自动腹膜透析或持续不卧床腹膜透析治疗。结论 维持性透析患者手术治疗的风险较高，但经过恰当的围手术期处理，多可耐受手术。加强围手术期的处理尤其是透析方式的调整有助于患者安全度过围手术期。

Objective Discussion on maintenance dialysis patients with the feasibility of accepting surgery and perioperative management. Methods One-hundred-seventy-five maintenance dialysis patients (including hemodialysis and peritoneal dialysis) were selected into a retrospective study. Then we investigated their information related to the surgery, compared with the changes of hemoglobin、electrolyte、kidney function、 blood pressure between pre- and post-operation, record whether or not there were surgical complications, discuss the perioperative management and summarize the adjustment of dialysis programme during perioperative period. Results Among 175 cases of maintenance hemodialysis patients , 18 cases need surgical operation,accounting for 10.28% of dialysis patients.13 patients undergoing 18 cases of operations. Preoperative Hemoglobin (Hb) level were (97.35 t difference were found in the electrolytes、kidney functions and blood pressures between pre- and post-surgery. 2 cases of patients happened surgical complications which were hypotension and respiratory failure.1 patient died. The dialysis programmes need to be adjusted , different dialysis methods can be selected including continuous renal replacement therapy、without heparin hemodialysis、automatic peritoneal dialysis or continuous ambulatory peritoneal dialysis，according to the surgery conditions and the patientsConclusions Patients with maintenance dialysis have high risks of surgery. But after correct and appropriate perioperative management, most of them can tolerate surgery. Strengthen the perioperative management, especially the adjustment of dialysis modalities, will help to these patients to survive the perioperative period.