46例移植肾切除回顾性分析

目的:探讨移植肾切除的原因和手术安全性。方法:回顾分析复旦大学附属中山医院25年来626例肾移植患者中46例移植肾切除的原因和并发症。结果:切除的46例移植肾中急性排斥反应20例(45.20%),慢性排斥反应16例(34.78%),加速排异2例,动脉栓塞1例,感染4例,肾破裂2例和肾动脉破裂1例。感染和出血为术后最多见的并发症,共9例(19.56%),死亡2例(4.34%)。环孢素A(CsA)使用后移植肾切除率7.72%,与CsA使用前的27.78%相比移植肾切除率明显减少(P<0.01)。结论:移植肾切除的主要原因是急慢、性排斥反应。CsA的使用是移植肾切除减少的原因之一。移植肾切除手术风险大,并发症多,手术前后合理的处理可增加手术安全性。

Transplant Nephrectomy:a Retrospective Study of 46 Cases

Objective: To evaluate the causes and safety of transplant nephrectomy. Methods:A total of 626 kidney transplantations were performed from cadaveric donors between 1977 and 2002 Zhongshan Hospital at Fudan University. This study analyzes 46 transplant nephrectomies in 626 kidney transplantation retrospectively. The patient records were reviewed for causes of allograft nephrectomy, route of allograft nephrectomy, and complication rate. Results: Among 46 transplant nephrectomy cases, there were 20 cases of acute rejection, 16 cases of chronic rejection, accelerated rejection and renal allograft rupture in 2 cases, renal-artery thrombosis and renal-artery rupture in 1 cases, graft sepsis in 4 cases. The total complication rate was 19.56% and included mainly pulmonary infection and wound hematoma. The frequency of transplant nephrectomy was lower in recipients of cyclosporine A(CsA) (7.72%)than that in the precylosporine(27.78%)(P<0.01) era. Conclusion: The main pathological causes of allograft nephrectomy were acute, chronic rejection. The frequency of transplant nephrectomy has decreased since the introduction of CsA. The appropriate peroperative management may decrease incidence of postoperative complication.