巨大多囊肾尿毒症患者摘除一侧囊肾同期同侧肾移植

目的 探讨巨大多囊肾尿毒症患者同期囊肾摘除同侧肾移植手术的安全性及临床疗效. 方法对45例终末期多囊肾尿毒症患者应用2种术式行.肾移植:腹膜外囊肾摘除同期同侧髂窝植肾23例(A组),保留囊肾常规植肾22例(B组),观察2组平均术后住院时间、术后2周血压、腹围、肺活量,肺总量、1 s用力呼吸容积占用力肺活量比值(FEV1.0/FVC)、肾功能延迟恢复(DGF)发生率、1年人/肾存活率. 结果 A组术后住院(14.5±2.6)d、术后血压较术前下降(30.0±0.7)/(13.3±8.4)mm Hg(1 mm Hg=0.133 kPa)、腹围缩小(11.0士6.3)cm、肺活量增加(1.4土0.3)L、肺总量增加(2.0±1.0)L、FEV1.0/FVC增加(5.3±1.0)%、DGF发生率8.7%(2/23)、1年人/肾存活率100.0%/95.7%.B组术后住院(28.4±7.9)d、术后血压较术前下降(3.9±11.2)/(2.9±12.0)mm Hg、腹围缩小(3.3±2.2)cm、肺活量增加(0.4±0.3)L、肺总量增加(0.8±0.2)L、FEV1.0/FVC增加(2.0±0.9)%、DGF发生率9.1%(2/22)、1年人/肾存活率100.0%/95.5%.2组间DGF发生率、1年人/肾存活率比较差异无统计学意义(P>0.05),其余数据2组间比较差异均有统计学意义(P<0.05). 结论 多囊肾尿毒症患者摘除一侧囊肾同期同侧肾移植安全、便利,适合于囊肾巨大妨碍植肾操作的患者,能明显改善患者高血压、腹胀、呼吸不畅等症状.

One side polycystic kidney removal and homonymy kidney transplantation simultaneously for giga-polycystic kidney disease of terminal stage

Objective To investigate the security and result of operation of one side polycystic kidney removal and homonymy kidney transplantation simultaneously for giga-polycystic kidney di-sease of terminal stage. Methods Forty-five patients with polycystic kidney of transplantation were retrospectively analyzed. The patients were divided into 2 groups. Patients of group A (n=23) under-went resection of the cystic kidney by extraperitoneum and the other 22 patients(group B) didn't re-move the cystic kidney. The data including average length of hospital stay, variance of blood pressure, lessen of abdominal circumference, lung capacity, total lung capacity, FEV1.0/FVC, incidence rate of delayed graft function (DGF) and 1 year patient/kidney survival rate of the 2 groups were compared. Results The average length of post-operative hospital stay of group A was (14.5±2.6)d,lessen of blood pressure was (30.0±0.7/13.34±8.4)mm Hg, lessen of abdominal circumference was (11.0+ 6. 3) cm, lung capacity increased (1.4±0.3)L, total lung capacity increased (2.0±1.0)L, FEV1.0/ FVC increased (5.3±1.0) %, the incidence rate of DGF was 8.7% (2/23), 1 year patient/ kidney survival rate was 100.0%/95.7%. The average length of post-operative hospital stay of group B was (28.45±7.9)d,lessen of blood pressure was (3.9±11.2/2.9±12. 0)ram Hg, lessen of abdominal circumference was (3.3±2.2)cm, lung capacity increased (0.44±0.3)L, total lung capacity increased (0.8±0.2) L, FEV1.0/FVC increased (2.0±0.9)%, the incidence rate of DGF was 9.1%(2/22), 1 year patient/kidney survival rate was 100.0%/95.5%. There were no significant differences of the incidence rate of DGF and 1 year patient/kidney survival rate between the 2 groups. While there were significant differences of the other data between the 2 groups(P＜0.05). Conclusions It is safe and convenient for one side polycystic kidney removal and homonyrny kidney transplantation simultaneous-ly for giga-polycystic kidney disease of terminal stage. The procedure could be applied to the patients of graveness complication or giga-polycystie kidney hampering operation of transplantation.