肾错构瘤破裂出血诊治体会(附29例报道)

目的探讨肾错构瘤自发性破裂出血的诊断和治疗方法。方法回顾性分析了2005至2011年诊治的29例肾错构瘤自发性破裂出血患者的临床资料,其中20例急诊行手术治疗,3例行介入栓塞治疗,6例行保守治疗。结果 20例行急诊手术治疗患者术后恢复良好,3例行介入栓塞治疗患者病情稳定,6例行保守治疗患者中3例病情稳定,另外3例保守治疗过程中改行手术治疗。结论 B超和CT检查是诊断肾错构瘤自发性破裂出血的重要方法,外科手术仍为肾错构瘤破裂出血的主要治疗方法。     

自发性食管破裂的临床特征和外科治疗

目的 总结自发性食管破裂的临床特征和治疗经验,提高对该病的诊治水平.方法 总结和分析1954年10月～2006年4月收治的15例自发性食管破裂患者的临床资料.本组患者发病时间均超过24 h,均经上消化道造影或口服亚甲蓝后胸腔穿刺证实为自发性食管破裂.开胸手术治疗12例:其中行食管裂口修补术11例,行食管部分切除、食管胃吻合术1例.加做空肠造瘘术7例,加做胸膜剥脱术3例.保守治疗3例.结果 痊愈9例(60%),自动出院3例,死亡3例.结论 呕吐后胸痛或腹痛患者,要考虑自发性食管破裂.上消化道造影或口服亚甲蓝后胸腔穿刺可以明确诊断.发病时间超过24 h不是选择保守治疗的适应证,患者一般状况允许时,应积极手术治疗,尽量选择食管裂口修补术.     

彩色多普勒血流与肾穿刺活检在移植肾排斥反应中的临床应用

目的 探讨彩色多普勒血流(CDFI)与肾穿刺活检在移植肾排斥反应中的临床意义.方法 对73例肾移植术后患者行CDFI检查,对移植肾的二维超声、血流阻力指数(RI)、动脉搏动指数(PI)与穿刺活检病理结果 进行分析.结果 73例肾移植患者超声引导下经皮肾穿刺活检显示:稳定期37例,急性排斥反应15例,慢性排斥反应11例,肾小管坏死7例,环孢素中毒3例.二维超声检测急、慢性排斥反应的移植肾体积及皮质厚度均明显高于稳定期(P＜0.01).肾动脉CDFI示急性排斥反应、慢性排斥反应、肾小管坏死、环孢素中毒的RI、PI均较稳定期增高(P＜0.01).结论 CDFI对移植肾术后功能的评估起到重要的作用,移植肾穿刺活检病理结果 是最准确的金标准,能够及时准确地对排斥反应进行诊断和疗效判断.     

原发性肝癌自发性破裂出血的诊断与治疗

目的 探讨原发性肝癌自发性破裂出血的诊断及治疗的方法.方法 回顾性分析21例原发性肝癌自发性破裂出血患者的诊断和治疗结果.结果 21例患者中,行保守治疗2例,1例死亡;肝动脉插管栓塞术3例,均成功;手术治疗16例,死亡3例.结论 原发性肝癌白发性破裂出血的诊断主要依靠病史、超声及CT检查,治疗应根据患者的病情、肝功能状态及肿瘤的局部情况而采取相应的治疗措施,包括保守治疗、肝动脉插管栓塞术及手术等方法.     

外伤性肾损伤合并脾破裂32例诊治体会

目的：总结32例肾损伤并脾破裂的诊断与治疗。方法：对32例肾损伤并脾破裂临床资料进行分析。结果：32例肾损伤并脾破裂患者中,保守治疗2例,手术治疗30例（脾切除8例,肾修补＋脾切除12例,肾切除＋脾切除6例,肾部分切除＋脾切除4例）,均痊愈出院。结论：肾损伤合并脾破裂诊断主要依靠外伤史、临床表现、尿检、B超和CT。Ⅲ级以上肾损伤即可考虑手术探查,手术治疗要尽可能保留肾功能。     

自发性食管破裂的临床特征和外科治疗

目的总结自发性食管破裂的临床特征和治疗经验，提高对该病的诊治水平。方法总结和分析1954年10月-2006年4月收治的15例自发性食管破裂患者的临床资料。本组患者发病时间均超过24h，均经上消化道造影或口服亚甲蓝后胸腔穿刺证实为自发性食管破裂。开胸手术治疗12例：其中行食管裂口修补术11例，行食管部分切除、食管胃吻合术1例。加做空肠造瘘术7例，加做胸膜剥脱术3例。保守治疗3例。结果痊愈9例（60％），自动出院3例，死亡3例。结论呕吐后胸痛或腹痛患者，要考虑自发性食管破裂。上消化道造影或口服亚甲蓝后胸腔穿刺可以明确诊断。发病时间超过24h不是选择保守治疗的适应证，患者一般状况允许时，应积极手术治疗，尽量选择食管裂口修补术。     

彩色多普勒超声对移植肾慢性排斥反应诊断的研究

目的探讨彩色多普勒超声对移植肾慢性排斥反应的诊断价值。方法对98例肾移植患者行彩色多普勒超声检查,其中移植肾慢性排斥反应组(排斥组)66例,肾移植术后正常组32例,测量两组移植肾的最大血流速度(Vmax)、搏动指数(PI)、阻力指数(RI),分析搏动指数与血肌酐(Scr)的关系。结果排斥组与正常组的Vmax分别为(20±7)cm/s、(23±5)cm/s,P相似文献   

自发性肾被膜下血肿临床诊断和治疗(附7例报告和文献回顾)

目的 探讨自发性肾被膜下血肿的临床诊断和治疗.方法 回顾性分析7例自发性肾被膜下血肿患者的发病、诊治和预后情况.结果 2例患者行保守治疗痊愈;2例患者采用开放手术,将血肿清除;3例患者采用腹腔镜下手术清除血肿.7例患者均治愈出院,出院时患肾功能基本正常.定期复查B超或CT,随访时间5～56个月,未见出血或肿瘤.结论 影像学检查是诊断自发性肾被膜下血肿的关键,应用腹腔镜治疗自发性肾被膜下血肿可取得良好的效果.     

16例自发性肾破裂的诊断与治疗分析

自发性肾破裂属于闭合性肾损伤,是指在无创伤情况下发生的肾实质、肾集尿系统或肾血管破裂,多在病理肾的基础上发生,但临床较为少见[1],如何准确诊断、评估病情是实施有效治疗的关键所在。本院于1990年3月—2011年10月收治自发性肾破裂患者16例,现将诊断与治疗分析报告如下。     

双层修补法治疗晚期自发性食管破裂

目的 总结双层修补法一期治疗晚期自发性食管破裂的经验.方法 对5例晚期自发性食管破裂患者应用双层修补法行一期食管修补术.结果 全组无手术死亡,术后胸腔引流管放置时间7～12 d,术后禁食时间12～25 d,均痊愈出院.术后4例患者随访1年均未见明显胃食管反流或食管狭窄,生活质量良好.结论 双层修补法一期治疗晚期自发性食管破裂疗效满意.     

彩色多普勒超声对移植肾慢性排斥反应诊断的研究

目的探讨彩色多普勒超声对移植肾慢性排斥反应的诊断价值。方法对98例肾移植患者行彩色多普勒超声检查。其中移植肾慢性排斥反应组（排斥组）66例，肾移植术后正常组32例，测量两组移植肾的最大血流速度（Vmax）、搏动指数（PI）、阻力指数（RI），分析搏动指数与血肌酐（Scr）的关系。结果排斥组与正常组的Vmax分别为（20±7）cm／S、（23±5）cm／S，P〈0．05；排斥组与正常组的阻力指数分别为1．25±0．21、0．67±0．13，P〈0．01；搏动指数分别为1．65±0．63、0．75±0．11，P〈0．01；随着阻力指数增大对慢性排斥反应诊断敏感性下降，而特异性上升；血肌酐随阻力指数增大而升高。结论彩色多普勒超声检查能反映移植肾的血流信息及其与肾功能的关系，有助于移植肾慢性排斥反应的诊断。     

Kidney transplant survival rates and surgical complications in kidney transplants in children; experiences in the Emma Children's Hospital AMC

OBJECTIVE: To describe surgical complications, and patient and kidney transplant survival rates in children who have had a kidney transplant. DESIGN: Retrospective. METHOD: Data were analysed concerning the children who had been treated with a renal transplantation in the period 1985-2001 because of terminal renal insufficiency in the Emma Children's Hospital of the Academic Medical Centre in Amsterdam, The Netherlands, with arbitrary end date October 7, 2002. RESULTS: In the study period, 55 primary kidney transplantations were performed on 24 girls and 31 boys. 13 living related and 42 post mortem transplantations were performed. The extra-peritoneal approach was performed in all recipients. Up to October 7, 2002, 14 surgical complications (25%) developed: 4 cases of renovascular thrombosis, 4 urinary leakages, 6 urethral strictures, 1 urethral necrosis, 5 haematomas and 3 lymphoceles. 6 patients lost their grafts due to surgical complications (11%); 4 due to thrombosis, 1 due to urethral necrosis and 1 due to haemorrhage or haematoma. Due to hypertension secondary to the underlying kidney disease 2 patients died within one year after transplantation from hypertensive encephalopathy and cerebral bleeding respectively. The one- and five-year graft survival was 83% and 74% for living related transplantations respectively, and for post mortem transplantations 78% and 68% respectively. The main causes of graft loss were chronic rejection (9/21; 43%), acute rejection (4/21; 19%), thrombosis (4/21; 19%) and surgical complications (2/21; 10%). Primary nonfunction was the only factor with a negative prognostic value for graft survival.     

下尿路异常患者的肾脏移植（附4例报告）

目的探讨下尿路异常患者肾脏移植的特点。方法2002年7月-2006年6月接受肾脏移植手术的下尿路异常患者4例。肾脏移植术前对患者进行仔细评估，手术中将移植肾输尿管再植入患者膀胱中，术后监测移植肾功能、尿常规、排斥反应情况，并对患者的生活质量满意度进行评价。结果2例患者术后肾功能恢复良好，未发生排斥反应，能够自行更换导尿管，有轻度尿路感染，控制满意，生活质量满意度良好。1例患者术后17d发生急性排斥反应，治疗后逆转，带有功能移植肾存活至今。1例患者术后因血管吻合部位反复出血导致移植肾丢失，恢复血液透析治疗。结论下尿路异常患者可以进行肾脏移植，但具有特殊性，仔细的术前评估、适当的尿液引流方式以及严密的术后随访是此类患者肾脏移植成功的关键。     

Causes of late renal transplant dysfunction

Renal transplantation is now established as the therapy of choice for end-stage renal failure. The causes of renal allograft loss have changed with the introduction of new immunosuppressive agents. In the pioneer era of transplantation most renal allografts were lost during the first year after transplantation due to acute rejection episodes. Nowadays, chronic allograft nephropathy became the leading cause of graft loss. The causes of chronic allograft nephropathy can be divided into alloantigen-dependent and alloantigen-independent factors. Acute rejection episodes and histoincompatibility have a significant influence on late graft function. Although alloantigen-related injury is of major importance, alloantigen-independent factors also play a significant role in the progression of chronic allograft nephropathy. Prolonged ischemia time leads to induction of inflammation, resulting in fibrotic scarring or proliferation of mesenchymal cells. Donor related factors such as donor brain death, age, nephron number and gender have a definite impact on late allograft function. Posttransplant complications such as hypertension, metabolic factors and viral infections contribute to accelerated deterioration of the functional units of the kidney. Immunosuppressive agents such as cyclosporine and tacrolimus may cause vasoconstriction and decreased glomerular filtration rate. Moreover, non-compliance is one of the most important risk factor for chronic allograft loss. Regardless of the cause of the initial injury the pathophysiology of chronic allograft nephropathy seems to be the same. All these factors can induce endothelial injury, which leads to increased expression of cytokines and growth factors resulting in proliferative processes, remodelling and scarring of the graft. This paper reviews current knowledge about risk factors and their effect on long-term renal allograft function.     

肾移植患者接受非移植相关手术20例围手术期处理分析

目的总结分析肾移植患者接受非移植相关手术的围手术期处理方法，主要是麻醉的处理方法。方法回顾性分析20例肾移植患者接受非移植相关手术的麻醉处理方法。结果20例患者中采用局部麻醉1例(5％)、椎管内麻醉4例( 20％)、全身麻醉15例(75％)。手术时间30～260 min，患者均安全平稳渡过围手术期。结论肾移植患者接受再次手术时对麻醉要求高，手术前麻醉医生要了解患者的病理生理状态，并与移植医生、手术医生有良好的沟通和相互配合。     

外周血淋巴细胞穿孔素和颗粒酶B在诊断移植肾急性排斥反应中的应用

目的探讨外周血淋巴细胞(PBL)穿孔素和颗粒酶B表达水平在肾移植诊断急性排斥反应(AR)和抗排斥疗效中的临床价值。方法采用定量逆转录PCR(RT-PCR)方法动态测定AR(7例)、肾功延迟恢复(8例)、近期肾功正常(27例)、长期肾功稳定(25例)的肾移植患者移植前后PBL穿孔素和颗粒酶B表达水平和AR的关系。结果肾移植术后患者PBL穿孔素和颗粒酶B表达强度依次为AR组、肾功延迟恢复组、近期肾功正常组、长期肾功稳定组,AR组与其他三组比较差异有统计学意义(P<0.01);其升高时间比临床上出现AR的症状早3d左右,随着AR的逆转,其表达也逐渐降至基线水平。结论定量RT-PCR测定PBL穿孔素和颗粒酶B的表达是一种无创、较敏感的早期诊断肾移植AR的方法,可以预测抗排斥反应的治疗效果。     

Projecting Long-Term Graft and Patient Survival after Transplantation

ObjectiveIn spite of increases in short-term kidney transplant survival rates and reductions in acute rejection rates, increasing long-term graft survival rates remains a major challenge. The objective here was to project long-term graft- and survival-related outcomes occurring among renal transplant recipients based on short-term outcomes including acute rejection and estimated glomerular filtration rates observed in randomized trials.MethodsWe developed a two-phase decision model including a trial phase and a Markov state transition phase to project long-term outcomes over the lifetimes of hypothetical renal graft recipients who survived the trial period with a functioning graft. Health states included functioning graft stratified by level of renal function, failed graft, functioning regraft, and death. Transitions between health states were predicted using statistical models that accounted for renal function, acute rejection, and new-onset diabetes after transplant and for donor and recipient predictors of long-term graft and patient survival. Models were estimated using data from 38,015 renal transplant recipients from the United States Renal Data System. The model was populated with data from a 3-year, randomized phase III trial comparing belatacept to cyclosporine.ResultsThe decision model was well calibrated with data from the United States Renal Data System. Long-term extrapolation of Belatacept Evaluation of Nephroprotection and Efficacy as Firstline Immunosuppression Trial was projected to yield a 1.9-year increase in time alive with a functioning graft and a 1.2 life-year increase over a 20-year time horizon.ConclusionsThis is the first long-term follow-up model of renal transplant patients to be based on renal function, acute rejection, and new-onset diabetes. It is a useful tool for undertaking comparative effectiveness and cost-effectiveness studies of immunosuppressive medications.     

Frequency and clinical characteristics of mycoplasma urinary tract infections in the early post-transplantation period in renal allograft patients

Using a highly sensitive and specific polymerase chain reaction (PCR) protocol, we studied 36 renal allograft recipients and 30 healthy controls. Midstream urine samples were analyzed using routine microbiological methods and the Mycoplasma IST (BioMerieux, France). Mycoplasma infections of the upper urinary tract were found in 9 patients. In three of them E.coli and Proteus were also present. We discuss the clinical characteristics of mycoplasma infections in the early post-transplantation period and its possible implications for graft rejection.     

外周血淋巴细胞穿孔素和颗粒酶B检测在诊断移植肾急性排斥反应中的价值

目的探讨外周血淋巴细胞(PBL)穿孔素和颗粒酶B表达水平在肾移植诊断急性排斥反应(AR)和抗排斥疗效中的关系。方法采用定量逆转录PCR(RT-PCR)方法动态测定AR(n=7)、肾功延迟恢复(n=8)、近期肾功正常(n=27)、长期肾功稳定(n=25)组67例肾移植患者移植前后PBL穿孔素和颗粒酶B表达水平和AR的关系。结果肾移植术后患者PBL穿孔素和颗粒酶B表达强度依次为AR组、肾功延迟恢复组、近期肾功正常组、长期肾功稳定组,AR组与其它3组差异有统计学意义(P<0.01);其升高时间比临床上出现AR的症状早约3d,随着AR的逆转,其表达也逐渐降至原有基础水平。结论定量RT-PCR测定PBL穿孔素和颗粒酶B的表达可以是一种无创的、较敏感的早期诊断肾移植AR的方法,并可预测抗排斥反应治疗效果。