肾移植患者再行肝肾联合移植诊疗体会(附3例报道及文献回顾)  

A Report of 3 Cases and Literature Review of Combined Liver and Kidney Transplantation after Renal Transplantation

作　　者：明英姿[1] 刘洪[1] 庄权[1] 佘兴国[1] 牛英[1] 邵明杰[1] 张朋朋[1] 曾启洪 周威[1] 阳敏[1] 叶啟发[1] 

机构地区：[1]中南大学湘雅三医院器官移植中心,湖南长沙410013

出　　处：《中国普外基础与临床杂志》2015年第9期1036-1041,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨肾移植患者再行肝肾联合移植的抉择问题,为肾移植术后再次出现肝肾功能异常与肝肾综合征的患者接受最合理有效的移植治疗提供经验,并对肝肾联合移植的风险因素、利弊以及手术指征予以总结。方法回顾性分析2014年2月至2015年1月期间笔者所在的移植中心成功完成的3例既往有肾移植手术史的患者再行肝肾联合移植的临床资料,并复习相关国内外文献。结果 3例患者手术均成功,术后肝肾功能均恢复良好,2例患者成功出院,其中1例患者术后2月余发生严重的肺部真菌感染,经过治疗好转;第3例患者术后1月余死于严重混合性感染。结论肾移植患者再行肝肾联合移植时手术技术和术后排斥反应不是影响该类患者预后的最主要问题,感染才是我们移植医生要面临的最大困难,改善患者术前的全身状况并且根据患者的情况来决定是否实施同步还是非同步肝肾联合移植,以及术后全面系统的治疗管理对提高患者术后长期存活是非常必要的。Objective To investigate the decision of combined liver and kidney transplantation （CLKT） after renal transplantation, provide surgical therapeutic experience for those patients with liver and renal insufficiencies and hepatorenal syndrome and summarize the risk factors, demerits and merits, and operative indications of CLKT. Methods The data of three successful CLKT cases of our centre from Feb. 2014 to Jan 2015 were retrospectively analyzed, and these three patients had kidney transplantation before. We also reviewed the latest associated literatures. Results Three patients got successful operations of CLKT and had very good recovery of renal function several days ofter operaton. Two of them discharged a few weeks after surgery, ajad one of these two patients got severe pulmonary infection of fungus two month after CLKT but recovered under proper therapy finally. The third patient died of severe mixed infection one month after CLKT. Conclusions The surgical techniques and rejection are not the main impact factor to the prognosis of CLKT after renal transplantation. Infection is the biggest trouble to which we should pay most of our attention. We should decide whether to do synchronous or nonsynchronous CLKT according to the situation before surgery. Moreover, the systematic therapy administration after CLKT is very necessary for the patients＇ long-term survival.

关 键 词：肝肾联合移植 肝肾综合征 肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]