公民逝世后器官捐献供肾移植后受者肾动脉破裂12例临床分析  

Renal Artery Rupture in Kidney Transplantation Recipients from Donation after Citizen's Death

作　　者：张学 张伟杰[2] 蒋继贫[2] 昌盛[2] Zhang Xue;Zhang Weijie;Jiang Jipin(Department of Breast Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China;Institute of Organ Transplantation,Key Lab of Ministry of Education ＆ Ministry of Health of China,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]武汉大学人民医院乳腺外科,武汉430060 [2]华中科技大学同济医学院附属同济医院器官移植研究所,国家卫计委/教育部器官移植重点实验室,武汉430030

出　　处：《华中科技大学学报（医学版）》2018年第4期482-484,498,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家卫生计生委卫生行业科研专项项目(No.201302009); 湖北省自然科学基金资助项目(No.2014CFB966)

摘　　要：目的探讨公民逝世后器官捐献(donation after citizen’s death,DCD)供肾移植术后移植肾动脉破裂的原因以及防治策略。方法回顾分析2010年11月至2015年12月期间同济医院收治的540例DCD供肾移植患者中,12例出现移植肾动脉破裂的临床资料。结果 12例肾移植受者术后出现移植肾动脉破裂。其中3例因资料不全无法判断破裂情况(25%,3/12),2例受者死亡,1例进行移植肾切除;9例为术后出现局部感染腐蚀血管引起动脉破裂(75%,9/12),发生1例受者死亡,8例移植肾切除。在9例感染中,共培养出真菌5株,细菌15株。其中真菌包括假丝酵母菌4株(80%,4/5),光滑球拟假丝酵母菌1株(20%,1/5);细菌包括屎肠球菌4株(26.67%,4/15),金黄色葡萄球菌3株(20.00%,3/15),铜绿假单胞菌3株(20.00%,3/15),大肠埃希菌2株(13.32%,2/15),肺炎克雷伯菌1株(6.67%,1/15),表皮葡萄球菌1株(6.67%,1/15),阴沟肠杆菌1株(6.67%,1/15)。结论 DCD供肾移植中,感染是引起移植肾动脉破裂的主要因素,积极预防和果断处理十分重要。Objective To explore the etiology and prevention strategy of renal artery rupture in kidney transplantation recipients from donation after citizen＇s death（DCD）.Methods A retrospective study was performed on the clinical data of 12 patients with renal artery rupture after kidney transplantation from Nov.2010 to Dec.2015 in Tongji Hospital.Results Twelve patients with renal artery rupture after kidney transplantation were selected.Among those with renal artery rupture,three cases had incomplete data about the rupture condition（25%,3/12）,two recipients died and one case received transplant nephrectomy;local infection damaged vessels,leading to arteriorrhexis in nine cases（75%,9/12）,one died and eight received transplant nephrectomy.In the 9 cases of infection,5 strains of fungi and 15 strains of bacteria were detected.Fungi included：Candida albicans（80%,4/5）,Candida iusitaniae（20%,1/5）.Bacteria included：Enterococcus faecium（26.67%,4/15）,Staphylococcus aureus（20.00%,3/15）,Pseudomonas aeruginosa（20.00%,3/15）,Escherichia coli（13.32%,2/15）,Klebsiella pneumoniae（6.67%,1/15）,Staphylococcus epidermidis（6.67%,1/15）,Enterobacter cloacae（6.67%,1/15）.Conclusion Infection is the major factor of renal artery rupture in kidney transplantation from DCD donors.In order to reduce the incidence and mortality,active prevention and decisive treatment are very important.

关 键 词：公民逝世后器官捐献 肾移植 肾动脉破裂 感染 

分 类 号：R699.2[医药卫生—泌尿科学]