下尿路异常肾移植4例随访(英文)  

Kidney transplantation for treating lower urinary tract abnormality A follow-up in 4 cases

作　　者：裴向克[1] 蔡明[1] 石炳毅[1] 

机构地区：[1]解放军总医院第二附属医院全军器官移植中心

出　　处：《中国组织工程研究与临床康复》2008年第31期6158-6160,共3页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:下尿路异常能够导致终末期肾病,但是在国内这部分患者没有得到足够的重视,并且因为移植物无功能及脓毒性并发症的高发生率,下尿路异常患者通常被认为不适合进行肾移植。目的:回顾性分析4例下尿路异常患者的肾移植特点及术后随访情况。设计、时间及地点:回顾性病例分析,于2002-07/2006-06在解放军总医院第二附属医院全军器官移植中心完成。对象:接受同种异体肾移植的4例下尿路异常终末期肾病患者。方法:4例患者在肾移植术前接受了详细评估,术中将移植肾输尿管再植入原来膀胱中,尿液引流方式均采取膀胱造瘘方法。主要观察指标:监测肾移植术后患者及移植物存活率、移植肾功能、尿路感染、排斥反应情况,并对患者的生活质量满意度进行评价。结果:①2例患者术后肾功能恢复良好,未发生排斥反应,有轻度但容易控制的尿路感染,患者能够处理尿液引流并对生活质量满意度良好。②1例患者术后17d发生急性排斥反应,治疗后逆转,带有功能移植肾存活至今。③1例患者术后因血管吻合部位反复出血导致移植肾丢失,恢复血液透析治疗。结论:下尿路异常患者可以进行肾移植,但具有特殊性,仔细的术前评估、适当的尿液引流方式以及严密的术后随访是此类患者肾移植成功的关键。BACKGROUND： Lower urinary tract abnormality （LUTA） can lead to end-stage renal disease （ESRD）. However, insufficient attention has been paid to these patients in China, and they are usually thought unsuitable for kidney transplantation because of high incidences of graft dysfunction and septic complication. OBJECTIVE： To explore the characteristics and postoperative follow-up after kidney transplantation in four patients with LUTA. DESIGN, TIME AND SETTING： A retrospective analysis of LUTA cases was performed from July 2002 to June 2006 at the Organ Transplantation Center of Chinese PLA, Second Affiliated Hospital of General Hospital of Chinese PLA. PARTICIPANTS： Four ESRD cases of LUTA, who received allograft kidney transplantation. METHODS： Four cases of LUTA experienced detail evaluation before kidney transplantation. Ureter was reimplanted into the original bladder during transplantation and suprapubic cystostomy was performed as urinary drainage. MAIN OUTCOME MEASURES： Patient and graft survival, graft function, urinary tract infection （UTI） and graft rejection were supervised after surgery and quality of life was evaluated. RESULTS： Two patients recovered well with normal renal function and no rejection. Despite the moderate but easily controlled UTI, they handled the urinary diversion well and were satisfied with the quality of life. One patient experienced an acute rejection 17 days after transplantation and survived with functional graft until now after the rejection was reversed. One patient lost the graft for repeated hemorrhage at the site of vascular anastomosis, and then returned to hematodialysis. CONCLUSION： Kidney transplantation is suitable but special for patients with LUTA. Careful evaluation before transplantation, suitable urinary drainage and rigorous follow-up after surgery are keys to the success of kidney transplantation for this subgroup of patients.

关 键 词：肾移植 尿道疾病 器官移植 

分 类 号：R617[医药卫生—外科学]