肝移植后肾功能损害58例相关因素分析  

Related factor analysis of renal disfunction in 58 cases following liver transplantation

作　　者：曲明[1] 王营[1] 史艳芬[1] 杜英东[1] 尹惠生[1] 夏强[2] 张建军[2] 陈小松[2] 

机构地区：[1]解放军107中心医院肝胆外科,山东省烟台市264002 [2]上海仁济医院肝脏移植中心,上海市200127

出　　处：《中国组织工程研究与临床康复》2009年第44期8753-8756,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：回顾性分析解放军107中心医院肝胆外科58例肝移植患者围手术期肾功能的变化情况,以探讨肝移植患者围手术期肾功能损害的相关因素及治疗、预防经验。58例患者中男48例,女10例,年龄14-65岁,平均38岁。其中终末期良性肝病40例,肝脏恶性肿瘤18例。肝肾联合移植2例,二次肝移植2例。全部患者中,移植前肌肝超过正常值者40例,50例患者术前已应用利尿药物。移植后死亡8例,总生存率86%,10例患者肌酐持续增高,尿量进行性减少,给予连续性肾脏替代疗法治疗。其中2例在连续性肾脏替代疗法治疗过程中肾功能逐渐恢复正常,2例患者肾功能逐渐恢复正常后因合并肝功能衰竭、严重肺部感染而死亡,另6例患者因肾功能损害进一步加重,分别合并肺部感染、心功能衰竭、腹腔感染而死亡。可见,肾脏功能损害的有效处理及预防对于肝移植手术成功率具有重要意义。Changes of renal function in 58 patients who received liver transplantation at the Department of Hepatobiliary Surgery,the 107 Central Hospital of Chinese PLA were retrospectively analyzed in order to investigate related factors,treatment,and prevention of renal disfunction during operation.Among 58 patients,there were 48 males and 10 females,aging from 14 to 65 years with the mean age of 38 years.In particular,40 patients had fulminent benign liver disease,and 18 patients had liver caicinoma.Two patients received combined liver and renal transplantation,and 2 patients received second liver transplantation.In all the patients,serum creatinine level was higher than normal value in 40 patients before liver transplantation.Before operation,50 patients had accepted diuretics.Eight patients died after operation,and the total survival rate was 86%.Ten patients was given continues renal replacement therapy because of the increasing serum creatinine level and progressive hypourocrinia.Renal function of 2 patients was normal gradually,and renal function of another 2 patients was normal gradually but cases died due to serious liver function failure and severe pulmonary infection.Renal function of another 6 patients was damaged progressively and cases died due to pulmonary infection,heart failure,and peritoneal infection finally.So prevention and treatment of renal dysfunction is essential for promoting the successful rate of liver transplantation.

关 键 词：肝脏移植 肾功能损害 持续性肾脏替代治疗 

分 类 号：R617[医药卫生—外科学]