亲属活体供肾移植86例近期并发症分析  

Analysis of Early Complications of 86 Living Donor Kidney Transplants

作　　者：杨华[1] 李恒[1] 王振迪[1] 邵长帅[1] 袁帅[1] 陶维雄[1] 曾甫清[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022

出　　处：《临床泌尿外科杂志》2009年第11期809-811,共3页Journal of Clinical Urology

摘　　要：目的:总结和分析86例亲属活体供肾移植的近期并发症和诊治经验。方法:回顾性分析2003年11月～2009年4月86例亲属活体肾移植的临床资料。其中6例为夫妻间供肾,80例为直系血缘亲属供肾。供体均为开放手术取肾,受体首次移植84例,再次移植2例,术后采用环孢素A(或他克莫司)加霉酚酸酯(或硫唑嘌呤)加泼尼松预防排斥反应。结果:86例供体取肾术后7～10天出院,所有供体随访3～12个月,肾功能正常。86例受者中术后发生急性排斥反应8例,均经甲泼尼龙或抗胸腺细胞球蛋白治疗逆转。6例发生术后肺部感染,死亡2例。4例发生移植肾功能延迟恢复,其中1例并发移植肾周血肿合并弥漫性血管内凝血,最后因多器官功能衰竭死亡。术后移植肾周血肿再次手术6例,5例治愈。发生尿瘘6例,经保守治疗痊愈。83例存活者随访至今,其中术后1年发生慢性移植物失功2例,移植肾功能正常81例。结论:活体亲属供肾移植安全、疗效好,术后应高度重视和正确处理并发症,以获得人肾的长期存活。Objective：To summarize and analyze the early complications of living donor kidney transplantation （LDKT） and its therapeutic methods. Methods： The clinical data of 86 cases of LDKT cases were retrospectively analyzed November 2003-April 2009. Donor population were comprised of 80 blood related and 6 unrelated （spouse to spouse）. All donors underwent open nephrectomy. In 86 cases of recipients, 2 cases were second transplanta tion and the others were the first time. Triple-combined immunosuppressive protocols consisted of calcineurin in hibitor （CNI）, mycophenolate mofetil（MMF） or azathioprine（Aza） and steroid. Results： All donors hospital stay was 7 to 10 days postoperatively without any severe surgical complications. All donors kept their normal kidney function within 3 to 12 months＇ follow-up. Rejection episode occurred in 8 cases, which were reversed by methylprednisone or antithymocyte globulin （ATO）. Pneumonia developed in 6 cases, of which 4 cases were cured and 2 cases failed. 4 cases suffered DGF, one of them accompanied with hematoma, which died because of DIC and MODS . Allograft hematoma requiring surgically removed was found in 6 cases and five cases were cured. Urinary leakage was happened in 6 recepients ,who were cured by conservative treatment. 83 cases of recipients survived, in which 81 eases kept their normal function kidney and 2 cases occurred chronic allograft nephropathy after one year. Conclusions： LDKT is safe and feasible with good long-term results. The postoperative early complications of transplantation must be diagnosed and treated correctly in early stage, which is important for the long-outcome of patient and graft survival.

关 键 词：肾移植 活体供者 并发症 

分 类 号：R699.2[医药卫生—泌尿科学]