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1.
1978年4月至1994年3月共实施尸体肾移植591例,606次。迄今人存活510例(86.3%),死亡96例(16.2%),肾脏存活434例(73.4%),摘除移植肾76例(12.8%)。术后应用Aza,泼尼松(Pred),环磷酰胺,环孢素(CsA)、ATG、OKT3免疫抑制剂。发生超急性排斥9例次,急性排斥反应212例次,慢性排斥反应58例次。本组带肾存活最长13年3个月,术后1、3、5、10年肾存活分别为420例(85.7%),222例(77.4%),118例(69.8%),1例(16.7%)。就怎样合理地选用免疫抑制剂,术后并发症发生的原因,长期存活的经验进行讨论。 相似文献
2.
尸体肾移植1 082例次报告 总被引:9,自引:0,他引:9
对同种异体肾移植1051例1082例次进行总结。术后发生超急性排斥反应12例次,加速性排斥反应3例次,急性排斥反应289例次,慢性排斥反应93例次。人/肾总存活率:1年94.7%/87.6%、3年89.8%/79.7%、5年88.3%/79.1%、10年50.0%/38.6%。最长者存活16年5个月。1082例次的临床研究表明:(1)尸体肾移植是治疗晚期肾脏疾病的有效方法。(2)适应证的选择是保证肾移植成功的关键。(3)良好的HLA配型有利于减少移植肾的早期失功和提高肾移植的长期存活率。(4)高质量的供肾、快速的取肾和熟练的植肾手术是保证肾移植成功的重要条件之一。(5)应坚持ABO血型、淋巴细胞毒性试验及PRA配型工作。(6)合理的应用免疫抑制剂,将激素减到最低量及环孢素血浓度的监测甚为重要。(7)ATG或OKT3是当前治疗移植肾难治性排斥反应最有效的免疫抑制剂之一。(8)感染是肾移植失败的重要原因,要充分做好预防感染的工作。(9)彩色多普勒超声和ECT测定是一种方便、快速、敏捷诊断急性排斥反应的手段。(10)加强对肾移植患者随访,指导康复期治疗,随时调节免疫抑制剂,这对患者能否长期存活有重要意义。 相似文献
3.
终末期糖尿病肾病患者的肾移植:(附32例报告) 总被引:1,自引:0,他引:1
对32例终末期糖尿病肾病(ESDN)患者进行同种异体肾移植手术,经严格术前选择、取肾、植肾、术后治疗,30例人/肾存活(937%),2例失败(63%)。1年人/肾存活27例(844%),2年22例(688%),3年15例(469%),5年5例(156%)。就ESDN接受肾移植手术的国内外现状、诊断标准及移植肾长期存活等问题进行讨论。 相似文献
4.
不同分型的高位胆管癌手术切除方式的选择 总被引:3,自引:1,他引:3
1991年1月至1995年12月,本院收治高位胆管癌52例,手术切除17例,切除率32.7%。切除组中2例I型和1例Ⅱ型肿瘤行单纯局部切除,14例行联合肝叶切除;其中1例Ⅱ型行尾叶切除,1例Ⅱ型和3例ⅢA型行肝中叶切除,8例ⅢB型行左半肝切除,1例ⅢA型行右半肝切除。镜下治愈性切除率为15.4%(8/52)。治愈性切除组平均生存期为21.1月,姑息性切除组则为7.5个月(P〈0.05)。切除组手术 相似文献
5.
肛管直肠恶性黑色素瘤临床病理误诊分析 总被引:4,自引:0,他引:4
目的 分析肛管直肠恶性黑色素瘤临床及病理误诊的原因,探讨避免误诊的方法。方法 对15例肛管直肠恶性黑色素瘤进行回顾性分析和免疫组化观察。结果 临床误诊率为86.7%(13/15)。其中误诊为良性病变占66.7%(10/15),误诊为痔或痔伴有肛周脓肿7例、息肉2例及慢性炎症1例;3例误诊为肛管直肠癌。延误诊治时间3个月至1年。活检病理误诊率为53.3%(8/15),其中误诊为低分化腺癌6例,平滑肌 相似文献
6.
通过免疫组化ABC法,对50例手术切除或活检的膀胱癌标本石蜡切片进行P_(53)基因表达的研究。结果表明:膀胱P_(53)蛋白过度表达率为42%(21/50),其中PT_240%(12/30),PT_382%(9/11),PT_a,PT_1为0;G_232%(8/25),G_372%(13/17),G_1为0。随访25例患者,13例P_(53)阳性过度表达,其中有76%(10/13)有复发转移,而单纯复发者只占23%(3/13)。13例P_(53)阳性表达者平均存活时间22.6个月/例,12例P_(53)阴性表达者平均存活63.7个月/例。P<0.01。 相似文献
7.
中晚期肾母细胞瘤的综合治疗(附50例报告) 总被引:2,自引:0,他引:2
目的 总结肾母细胞瘤综合治疗效果。 方法 自1972 年3 月~1992 年6 月对50 例肾母细胞瘤患儿采用患侧肾根治性切除术、放疗( 根据患儿年龄,总量1 600 ~4 000cGy)、化疗( 长春新碱、更生霉素单独或联合应用) 的综合治疗措施。 结果 5 、10 年生存率为72% (36/50) 和53%(18/34);小于5 岁与大于5 岁年龄组,10 年生存率分别为60 %(15/25) 、33 %(3/9),差异有显著性(P<0 .05);术后10 天内与30 天后接受放疗者5、10 年生存率分别为83 %(10/12)、58 % (7/12)和53%(8/15)、33% (5/15),差异有显著性( P< 0-05) 。 结论 肾母细胞瘤综合治疗是提高生存率的关键。年龄越小,接受放疗时间越早,疗效越好。 相似文献
8.
评价无支架异种生物瓣膜主动脉瓣替换术后2年左室功能的变化。将80例同期施行主动脉瓣替换病人分为2组,50例(年龄69.3±9.3岁)应用TorontoSPVTM瓣;30例(年龄71.6±7.7岁)作为对照组接受支架人工瓣膜替换。术前、术后1、6、12及24个月间记录M型及Doppler超声心动图,采用计算机图像数字分析,定量测定左室功能的变化。随访期间,Toronto组主动脉瓣跨瓣压差为0.8±0.6kPa(6.0±4.5mmHg),明显低于对照组2.3±0.9kPa(17.3±6.8mmHg);术后1个月,左室心肌质量下降25%,左室+Vcf及-Vcf明显增加(2.0±0.8/1.4±0.3s-1,P<0.01;2.8±1.2/1.8±0.7s-1,P<0.01)。术后6个月,左室功能进一步改善,心室肥厚的消退更趋完全,该变化在其后的随访期间保持稳定。结论:与支架瓣膜相比,无支架异种生物瓣膜具有较大瓣口开放面积及低跨瓣压差,这促进了术后左室功能的恢复及病理性肥厚的逆转 相似文献
9.
腹部手术后肠瘘的治疗 总被引:10,自引:0,他引:10
为提高手术后肠瘘的治愈率,作者总结了1989年12月至1996年10月间收治的腹部手术后肠瘘24例,包括十二指肠瘘6例,高位小肠瘘3例,低位小肠瘘7例,结肠瘘8例,16例行保守治疗,治愈率75%(12/16),8例行手术治疗,治愈率87.5%(7/8),全组死亡率20.8%(5/24),作者认为治疗应遵循以下原则:(1)明确诊断;(2)结合生长抑素的应用加强营养支持治疗;(3)控制感染;(4)针对 相似文献
10.
再次肾移植的临床研究 总被引:8,自引:1,他引:7
目的 探讨影响再次肾移植效果的因素。方法 对再次肾移植的43例患者按术后用药方案的不同分2个组进行回顾性分析。结果 术后急性排斥反应(AR)的发生率为27.9%急性肾小管坏死(ATN)的发生率为23.3%,移植后人/肾、1、3、5年存活率分别为82.4%/64.7%、78.3%/60.9%、66.7%/55.5%。环孢素A(CsA)组和抗淋巴细胞球蛋白组人/肾1年存活率分别为77.8%/55.6% 相似文献
11.
Inci K Duzova A Aki FT Bilginer Y Erkan I Tasar C Bakkaloglu A Bakkaloglu M 《Transplantation proceedings》2006,38(2):541-542
Our aim was to investigate the semen variables and hormone profiles among transplant patients who received kidneys during adolescence. Seven postpubertal transplant patients who underwent successful renal transplantation during adolescence (13-19 years; 3 were preemptive) were enrolled in our clinical follow-up. Serum levels of prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone were checked together with the semen analysis. The ages of the patients ranged from 18 to 25 years (median, 22 years). The median age was 15 years (range, 12-18 years) at initial presentation. The median time between initial diagnosis and transplantation was 12 months (range, 2-60 months). The median follow-up after transplantation was 51 months (range, 23-134 months). Three of the seven patients had unilateral low testicular volume. The renal function tests were within normal limits, as well as serum levels of prolactin, FSH, LH, and testosterone. Sperm counts ranged from 0.2 to 55 million/mL (median, 1.7 million/mL). Only 1 patient (14.2%) had normal sperm parameters. Oligoteratozoospermia (low sperm count and defects in morphology) was observed in 1/7 (14.2%), asthenoteratozoospermia (low levels of motility and defects in morphology) in 1/7 (14.2%), and all parameters were abnormal in 4/7 (57.1%) cases. Our data suggest that in contrast to adult patients, semen variables are severely affected and spermatogenesis does not improve after renal transplantation when the patient was subjected to uremia before or during adolescence, the crucial period for spermatogenesis. 相似文献
12.
Cocchiara G Romano M Buscemi G Maione C Maniaci S Romano G 《Transplantation proceedings》2007,39(10):3041-3043
From January 1999 to February 2007, 61 end-stage renal disease (ESRD) candidates for kidney transplantation underwent an esophagogastroduodenoscopy (EGDS) to detect Helicobacter pylori (HP). We correlated treatment for HP before transplantation and upper digestive tract hemorrhagic complications and possible recurrence of peptic disease posttransplantation. The 32 (52.4%) HP-Positive cases were divided into 2 groups: (1) 17 patients who underwent treatment for the eradication of the infection with 40 mg/d omeprazole for 4 weeks, 500 mg claritromycin twice daily for 7 days, and 2 g/d amoxicillin for 7 days; and (2) 15 untreated patients. No significant differences were found in the hemorrhagic erosive gastritis of patients with regard to the treated HP-Positive and nontreated HP-Positive patients (2 vs 3) and between the HP-negative patients and the nontreated HP-Positive patients (2 vs 3). The presence of gastric or duodenal ulcers was significantly higher in the nontreated patient than in the treated HP-positive patients (5 vs 1; P=.05) and significantly higher in the nontreated HP-Positive patients than in the HP-negative patients (5 vs 0; P=.05). We concluded that HP-positive patients should therefore be treated for the infection to avoid a long-term significant increase of gastric and/or duodenal peptic disease subsequent to renal transplantation in these immunodepressed subjects. 相似文献
13.
非骨水泥全髋关节置换术治疗肾移植术后股骨头坏死的短期疗效 总被引:1,自引:0,他引:1
目的 探讨非骨水泥全髋关节置换术(total hip replacement,THR)治疗肾移植术后股骨头坏死(osteonecrosis of the femoral head,ONFH)的短期疗效.方法 回顾性总结非骨水泥THR治疗肾移植术后ONFH患者17例(22髋),男11例,女6例;平均年龄38.4岁(25~64岁).ONFH按ARCO标准分期,Ⅱ C期1例(1髋),ⅢB期2例(3髋),ⅢC期4例(5髋),Ⅳ期10例(13髋).除4例患者THR术前1~5个月停用激素外,其他患者围于术期和术后均维持使用免疫抑制剂.肾移植术前接受血液透析时间平均为16个月(0~87个月),肾移植术至接受THR的平均时间为3.4年(1.5~6年).全部采用非骨水泥THR,Versys股骨假体和Trilogy髋臼假体各5髋,Zweymuller股骨假体和EP-FIT髋臼假体各17髋;金属头对聚乙烯臼13髋,陶瓷头对陶瓷臼9髋.结果 17例患者全部获得随访,平均随访2.3年(11个月~5.1年).Harris评分为优15髋(68.2%),良7髋(31.8%);从术前平均(41.3±6.4)分提高到术后平均(92.2±7.1)分.术后并发症有切口浅表感染1例,下肢深静脉血栓1例,异位骨化1例,假体不稳定1例.结论 非骨水泥THR治疗肾移植术后ONFH可获得满意的短期疗效,长期应用激素和免疫抑制剂并不影响假体的早期稳定性,但中远期疗效有待进一步观察. 相似文献
14.
23例儿童肾移植临床分析 总被引:6,自引:0,他引:6
目的:探讨儿童肾移植的临床特点,提高肾移植效果。方法:对23例3~17岁的儿童肾移植资料进行回顾性分析。结果:术后随访5d至72个月,平均26.1个月,死亡1例,人、肾1年存活率分别为93.3%和86.6%。术后7例发生急性排斥反应,6例治疗后逆转,1例因并发移植肾静脉栓塞,切除移植肾;2例发生慢性排斥反应,1例移植肾功能丧失,恢复血液透析,另一例仍在随访治疗中;其它并发症有肺部感染4例,心力衰竭2例,肾静脉阻塞2例,肝功能损害2例,急性肾小管坏死1例。结论:儿童肾移植具有一定的特殊性,其血管较细、急性排斥反应发生率较高以及药物代谢快等都是应妥善处理的问题。 相似文献
15.
Oesterwitz H. Althaus P. May G. Schröder K. Strobelt V. Kaden J. 《International urology and nephrology》1983,15(4):347-357
An improved microsurgical technique for orthotopic rat kidney transplantation is described in detail. (1) End-to-end anastomosis of renal arteries with 7-8 interrupted 10-0 sutures. (2) End-to-end anastomosis of renal veins with 2 continuous semicircular 10-0 sutures. (3) Non-splinted end-to-end ureteric anastomosis with 4 interrupted full-thickness 11-0 sutures. (4) Simultaneous bilateral nephrectomy. Seventy transplantations were analysed. No failure due to complications of the vascular anastomoses occurred. The ureteric anastomoses were complicated by stenosis in only 5 animals (7%). The operation times for vascular anastomoses were 20 (15-24) minutes and for complete transplantation 50 (45-60) minutes. This technique seems to be less time consuming than other methods. Our method has produced a success rate of 93% with well standardized and reproducible organ quality. Preliminary clinical experiences with extracorporeal microvascular reconstruction in 4 cases of injured small polar kidney allograft arteries support the continued application in appropriate situations to increase the number of suitable donor kidneys. 相似文献
16.
Simultaneous revascularization of stenosed renal arteries during resection of aneurysms of the abdominal aorta was performed in a consecutive series of 30 patients (mean age: 65 +/- 7 years; men 27 [90%]; women 3 [10%]). Right renal artery was operated upon in 20/30 cases (66%) and left renal artery in 15/30 cases (50%) for a mean degree of stenosis of 79 +/- 19%. Suprarenal extension of the aneurysm of the abdominal aorta was observed in 7/30 cases (23%). Emergency operation because of rupture of the aneurysm was necessary in 7/30 cases (23%). The following procedures were performed upon the renal arteries, either isolated or combined, in addition to resection of the aneurysm of the abdominal aorta: reimplantation of the renal artery in 15 cases, thrombendarteriectomy of the renal artery in 11 cases, patchangioplasty in 8 cases, bypass in 4 cases, dilatation in 1 case, autotransplantation in 1 case. The 30-day mortality was 1/23 (4%) for elective procedures versus 3/7 (43%) for emergency procedures (ruptures). Systolic (diastolic) blood pressure dropped from a preoperative mean value of 181 +/- 139 (104 +/- 18) mm Hg to a postoperative mean value of 147 +/- 18 (80 +/- 18) mm Hg: p less than 0.05 (p less than 0.05). Hence, simultaneous revascularization of stenosed renal arteries during resection of aneurysms of the abdominal aorta helps not only to salvage renal parenchyma but also to control the risk factor hypertonia in a significant number of patients. 相似文献
17.
目的 探讨夫妻供肾移植的临床效果及安全性.方法63例活体供肾移植供者分夫妻供肾组(n=12)和亲属供肾组(n=51)2组.总结夫妻活体供肾肾移植的临床资料,并与同期基础条件相近、免疫抑制剂方案相同、基因相关亲属供肾组的临床资料进行对比.观察指标选择平均住院时间、急性肾小管坏死发生率、1年内急性排斥反应发生率和移植后7、30 d和1年血肌酐(SCr)水平.结果 夫妻供肾组和亲属供肾组受者年龄分别为(39±3)和(37±3)岁,P=0.05;透析时间分别为(4.7±3.2)和(4.4±2.9)个月,P=0.78;平均住院时间分别为(20.9±8.3)和(23.0±7.8)d,P=0.41.2组1年内急性排斥反应发生率分别为33.3%4/12),3.9%(2/51),P=0.01.急性肾小管坏死发生率分别为16.7%(2/12),3.9%(2/51)(P=0.31).夫妻供肾组术后7、30 d SCr值分别为(206.47±47.22)和(163.75±25.91)μmol/L,亲属供肾组分别为(142.79±89.42)和(119.99±15.03)μmol/L,P=0.02,P=0.00.术后1年夫妻供肾组获随访9例,亲属供肾组40例;SCr分别为(133.40±6.11)和(121.00±34.12)μmol/L,P=0.25.结论 术前对夫妻供、受者进行全面综合评估是夫妻供肾移植成功的保证.夫妻供肾移植的近期急性排斥反应发生率略高于亲属活体供肾移植,但术后1年夫妻供肾移植受者的移植肾功能与亲属活体供移植受者比较并无区别. 相似文献
18.
目的探讨乙型肝炎病毒(HBV)和(或)丙型肝炎病毒(hepatitis C virus,HCV)感染对肾移植受者长期存活的影响及预防措施。方法 HBV和(或)HCV感染肾移植受者110例(感染组),其中HBV感染受者56例、HCV感染受者52例,HBV与HCV合并感染2例。非HBV与非HCV感染受者694例(非感染组)。感染组受者术前有病毒复制者予积极治疗,研究早期肝功能正常者可接受肾移植,后期均用聚合酶链反应(PCR)检测,要求连续3~6个月HBV脱氧核糖核酸(DNA)0copy/ml,HCV核糖核酸(RNA)0copy/ml方可接受肾移植。术后定期检测HBV与HCV,定期检测感染组受者HBVDNA滴度、HCVRNA滴度。发现HBV复制,选用拉米夫定、阿德福韦酯治疗,酌情减少免疫抑制剂用量。分别比较两组术后1、3、5年人、肾存活率,比较两组的肝功能衰竭病死率。结果非感染组人、肾存活率分别为:1年94.2%、91.4%,3年为86.4%、85.2%,5年为82.7%、78.9%;感染组人、肾存活率分别为:1年90.2%、88.1%,3年为88.9%、86.2%,5年为81.5%、76.3%;两组数据比较差异均无统计学意义(均为P>0.05)。感染组中14例(12.7%)死于肝功能衰竭,其中10例为HBV感染者,非感染组受者无1例死于肝衰竭。感染组术后肝衰竭病死率明显高于非感染组(12.7%、0,P<0.05)。结论受者术前HBV和(或)HCV感染会明显增加肾移植术后肝衰竭死亡危险。患者术前处于病毒复制期应予积极治疗,在肝炎病毒停止复制6个月后再考虑肾移植。长期随访中应定期复查HBV与HCV感染指标,早确诊、早治疗,并及时调整免疫抑制剂剂量。 相似文献
19.
目的 探讨不同免疫抑制剂对肾移植患者术后血脂变化的影响. 方法 肾移植术后患者283例,分别选择他克莫司(FK506),环孢素(CsA)和西罗莫司(SRL)免疫抑制剂治疗方案,比较不同免疫抑制剂患者移植前及术后不同时段血清总胆固醇(TC)和三酰甘油(TG)浓度差异. 结果 FK506组93例患者服药前与服药后96周血清TC和TG浓度分别为(4.9±1.1)、(1.45=0.8)mmol/L与(4.9±1.1)、(1.4±1.0)mmol/L,差异无统计学意义(P>0.05).CsA组106例患者分别为(4.8±1.0)、(1.6±0.8)mmol/L与(6.6±1.7)、(3.2±1.0)mmol/L,差异有统计学意义(P<0.01).CsA组和SRL组患者血清TC和TG浓度一般于服药后12~24周时开始升高.51例服用12周CsA后改为FK506,患者改药前及改药后72周血清TC和TG浓度分别为(6.7±1.1)、(2.8±1.0)mmol/L与(4.7±1.7)、(1.5±1.1)mmol/L,差异有统计学意义(P<0.01). 结论 脂质紊乱是肾移植患者非免疫因素引起慢性排斥反应和慢性移植物失功的重要原因,CsA和SRL是引起肾移植患者术后血脂增高的主要因素之一.对于高脂血症肾移植患者免疫抑制剂应用可优先考虑FK506,避免SRL、CsA合用而加剧血脂升高. 相似文献
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目的 研究肝移植术后暂停及转换钙调磷酸酶抑制剂(CNI)对控制感染和改善受损肾功能的作用.方法 回顾性分析单中心施行的947例原位肝移植的资料,分为2个阶段,第1阶段(2002年1月至2007年12月)有234例肝移植术后发生感染的患者,第2阶段(2008年1月至2010年12月)有101例.2个阶段共有329例受者因CNI肾毒性而造成肾功能损害,其中将CNI转换为SRL者40例(转换组),其余289例采取CNI减量+吗替麦考酚酯(MMF)加量方案(减量组).结果 肝移植术后存活超过1、3和5年者CNI的应用率分别为95.8%、95.3%和97.5%.第2阶段共有17例受者短期停用免疫抑制剂,停药的主要原因是细菌(部分合并真菌)感染(88.2%);2个阶段共有48例患者将CNI转换为SRL,换药主要原因是肾功能损害(83.3%).第2阶段感染患者中短期暂停CNI者15例,占14.9%(15/101),CNI暂停后感染控制的有效率为73.3%(11/15),排斥反应发生率为6.7%(1/15).第2阶段感染患者的累积存活率明显高于第1阶段(P<0.05).转换组CNI转换前肾小球滤过率为(0.82±0.24)ml/s,CNI转换后6周时为(1.28±0.31)ml/s,6个月时为(1.36±0.32)ml/s,转换后6周和6个月时高于转换前(P<0.05).CNI调整后6个月时,转换组患者存活率为85.0%,减量组为83.7%(P>0.05).结论 肝移植术后患者发生感染及肾功能损害时可采取CNI减量甚至短时间停用CNI,或转换使用SRL,此方案是安全、有效的.Abstract: Objective To report the results of a single-center, retrospective study on the effect of calcineurin inhibitors (CNI) withdraw for controlling infections and conversion to sirolimus (SRL)for ameliorating renal dysfunction. Methods A total of 947 liver transplant cases from 2002 to 2010were divided into two eras (Jan. 2002 to Dec. 2007 and Jan. 2008 to Dec. 2010). There were 234cases of infections after liver transplantation (LT) in the first era and 101 cases in the second era. And of 329 cases of CNI-related renal dysfunction after LT in two eras, 40 cases (converting group) had converted CNI to SRL, while 289 cases (reducing group) adopted protocol of CNI reducing and mycophenolate mofetil (MMF) raising. Results CNI-based IS took up 95.8 %, 95. 3 %, 97. 5 % of the IS protocols with recipient survival time longer than 1, 3, and 5 years. The primary cause for CNI withdraw was infection (88. 2 %, 15/17) in the second era, and renal dysfunction for conversion to SRL in the two eras (83. 3 %, 40/48). In the second era, 14. 9% (15/101) of the cases of infections after LT experienced CNI withdraw. Of the 15 patients, 11 had effectively controlled the infection (77. 3 %) while rejection rate was 6. 7 % (1/15). The cumulative survival rate of the second era was significantly higher than the first era (P<0. 05). The glomerular filtration rate (GFR) of converting group at 6th week and 6th month was statistically elevated as compared with that before conversion,respectively (1.28 ± 0. 31, 1.36 ± 0. 32 mL/s vs. 0. 82 ± 0. 24 mL/s, P<0. 05). Six months after CNI adjustments, survival rate of converting group and reducing group was 85. 0% and 83. 7 %,respectively (P>0. 05). Conclusion Reducing or even short-term withdraw of CNI may allow the better control of infections after LT, and the conversion from CNI to SRL can ameliorate the CNIrelated nephrotoxicity. These individually tailored IS protocols will benefit the long term survival for LT. 相似文献