To evaluate the efficacy of peripheral nerve decompression surgery in the treatment of moderate-severe uremic peripheral neuropathy (UPN) and to explore the possible mechanisms of action.

Fifty-three patients with moderate-severe UPN treated at Neurosurgery Department and Hemodialysis Center of Jinjiang Hospital from January 2022 to August 2024 were selected and randomly divided into a treatment group (27 cases) and a control group (26 cases) using a random number table method. The control group received conservative treatment, while the treatment group underwent peripheral nerve decompression surgery. The clinical effects of the two groups were evaluated using visual analog scale (VAS), Toronto clinical scoring system (TCSS), quantitative sensory testing (QST), nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV). Musculoskeletal ultrasound was used to measure the changes in nerve diameter and thickness in both groups before and after treatment. The concentrations of C reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) in the two groups were compared before and after treatment.

In the treatment group, 23 cases were included and 4 cases were shed, and in the control group, 24 cases were included and 2 cases were shed. There was no statistically significant difference in gender, age, average disease duration, average dialysis time, and primary disease between the two groups (P>0.05). The VAS and TCSS scores, VPT, and WPT of the treatment group were lower than those of the control group after treatment, and lower than those before treatment in the same group; the CPT, MNCV, and SNCV scores in the treatment group were higher than those in the control group after treatment, and were also higher than those before treatment in the same group, with statistically significant differences (P<0.05). The diameter of the muscle bone ultrasound nerve in the treatment group after treatment was smaller than that in the control group, and also smaller than that before treatment in the same group, with statistical significance (P<0.05). After treatment, the serum levels of CRP, TNF, IL-6, and IL-8 in both groups of patients were significantly reduced compared to before treatment, and the treatment group was lower than the control group, with statistically significant differences (P<0.05).

Peripheral neurolysis has significant clinical effects in the treatment of moderate-severe UPN. This surgical approach can effectively alleviate symptoms such as pain, cause swelling and compression of nerves, increase nerve conduction velocity, and reduce inflammatory reactions. The surgical safety is high and there are few adverse reactions.