慢性移植肾失功后的移植肾切除手术分析  

Analysis of removal of transplanted kidney after chronic renal allograft dysfunction

作　　者：张志宏[1,2] 管德林[1,2] 张凯[1,2] 金石华[1,2] 吴建臣 张继珍 黄靖 刘静[4] 黄真[4] 钱玉松[4] 张军[4] 徐凤梅[4] 那彦群[1,2] 

机构地区：[1]北京大学首钢医院 [2]北京大学吴阶平泌尿外科医学中心,北京100144 [3]清华大学第一附属医院泌尿外科 [4]首都医科大学北京佑安医院

出　　处：《临床泌尿外科杂志》2015年第2期156-159,共4页Journal of Clinical Urology

摘　　要：目的：分析总结因慢性移植肾失功而行移植肾切除手术患者的临床治疗经过,进一步探讨这类手术的安全性和适应证。方法：以慢性移植肾失功患者76例为研究对象,年龄23~72（36.6±13.5）岁,以上患者发生慢性移植肾失功的时间为术后11~91（35.8±24.6）个月,转入血液透析的时间为3~33（10.4±6.2）个月。76例患者均实施了移植肾切除手术,移植肾切除术后随访时间为6个月~5年。结果：平均手术时间50（35~180）min;术中平均出血量450（200~2 600）ml,平均输血量300（400~2 400）ml,其中67例进行了自体血液回收后输血。术后平均引流量250（20~1 100）ml,平均住院时间11（5~23）d。术后主要并发症：切口血肿8例,切口感染10例,消化道出血7例,心衰7例,肺部感染5例,肾上腺危象2例,下肢跛行2例。死亡4例。多数患者的体重指数、血红蛋白及血清白蛋白含量较术前有所提高。结论：慢性移植肾失功后的移植肾切除手术为高风险手术,应积极做好术前准备,同时加强围手术期护理,以降低手术并发症的发生率;积极适时地切除已经完全失功了的移植肾,有助于改善患者身体素质,避免免疫抑制的不良反应,同时有利于减轻患者本人及社会的经济负担。Objective：To analyse the experience of removal of transplanted kidney after chronic renal allograft dysfunction,explore the safety and indications of this surgery.Method：We studied 76 patients aged 23-72（36.6±13.5）years old,diagnosed as chronic renal allograft dysfunction in 11-91（35.8±24.6）months after operation,turned to hemodialysis for 3-33（10.4±6.2）months after operation.All the patients underwent removal of transplanted kidney.The follow-up period was 6-60 months.Result：The clinical data of patients were as follows：the mean operation time was 50（range,35-180）minutes;the mean blood loss was 450（range,200-2 600）ml;the mean blood transfusion was 300（range,400-2 400）ml,and 67 patients received autotransfusion;the mean postoperative drainage volume was 250（range,20-1 100）ml;the mean hospital stay was 11（range,5-23）days.The main complications included eight cases of incisional hematoma,ten cases of incisional infection,seven cases of gastrointestinal hemorrhage,seven cases of heart failure,five cases of pulmonary infection,two cases of adrenal crisis,and two cases of claudication.Four cases died.The body mass index,hemoglobin and serum albumin of most of patients improved after operation.Conclusion：Removal of transplanted kidney after chronic renal allograft dysfunction has a high risk.Careful preoperative preparation and perioperative nursing are the key point for preventing complications.An opportune time for removal of non-functioning kidney can improve patients＇ physicalconstitution,prevent immunosuppressive side effects,and reduce economic burdens both for patients and the whole society.

关 键 词：慢性移植肾失功 肾移植 肾切除 

分 类 号：R699.2[医药卫生—泌尿科学]