93例移植肾切除手术时机的探讨

目的 探讨移植肾探查切除手术的时机.方法 1996年1月至2006年12月我们共行肾移植手术1769例,行移植肾切除的病例93例,回顾其临床特征,探讨手术最佳时机.结果 93例中术后3个月内移植肾切除者34例,占34.40%,4～12个月者25例,占26.88%,大于1年者34例,占34.40%;血肌酐、尿素氮升高者83例,占89.25%;尿量减少者62例,占66.67%;移植肾区疼痛/膨隆者42例,占45.16%;发热者28例,占30.11%.切除移植肾病理学结果:超急性排斥反应5例,加速性排斥反应8例,移植肾破裂9例,肾动脉血栓/栓塞6例,移植肾动脉瘤3例,移植肾真菌感染2例,巨细胞病毒感染2例,急性肾小管坏死1例,移植肾间质化脓性炎症1例,移植肾动脉结节性炎伴肾梗死1例,移植肾动脉破裂1例,移植肾蒂出血1例,慢排或慢排+急排53例.本组移植肾切除术后有15例死亡,这其中死于多器官功能衰竭8例,占死亡者的53%,重症感染4例,占27%,颅内出血2例,占13%,心脏并发症1例,占7%.结论 首先移植肾切除手术是一高风险手术,移植肾或其他脏器一旦出现并发症,应及早手术探查,挽救患者的生命,终止它的恶性循环;其次在可能的情况下,调节患者各脏器功能,使其尽可能能耐受手术.

Operation opportunity for nephrectomy of transplanted kidney

Objective To explore the opportunity of nephrectomy of transplanted kidney. Methods The clinical data of 93 patients who underwent nephrectomy of transplanted kidney out of the 1769 patients who re4ceived kidney implantation between January 1996 and December 2006 were analyzed to discover the best opportunity of the nephrectomy of transplanted kidney. Results Thirty-four transplanted kidneys were resected within the three months after transplant, 25 implanted kidneys underwent resection during the period of 4 to 12 months after transplant, and 34 kidneys were resected one year after transplant. Serum creatinine before nephrectomy was above 115 μmol/L in 83 patients (89.25%). Urine quantity decreased in 62patients. 42 patients showed pain and swelling in the area of the transplanted kidney. Pathology of the reseeted implanted kidneys showed super-acute rejection (n=5) , accelerating-acute rejection (n=8),rupture of transplanted kidney (n=9), thrombus/embolism of transplanted kidney (n=6), aneurism of transplanted kidney (n=3), mycotic infection of transplanted kidney (n=2), CMV infection (n=2),acute necrosis of renal tubulus (n=1), interstitial pyogenesis of transplanted kidney (n=1) , inflammation of renal artery (n=1) , rupture of renal artery (n=1) , bleeding of transplanted kidney (n=1) , and chronic rejection and/or acute rejection (n=53). t5 patients died. 8 of which died due to multiple organ failure, 4 of which due to severe infection, 2 of which due to bleeding in encephala, and 1 due to heart disease. Conclusion Nephreetomy of transplanted kidney is a high risk operation, especially early after transplantation. Once complications occur to the transplanted kidney and/or other organ exploratory operation should be performed to rescue the life of the patients and to stop a vicious circle.