尸体肾移植术后围手术期并发症治疗体会

目的探讨尸体肾移植术后围手术期多种外科并发症治疗效果和治疗经验。方法收集郑州人民医院器官移植科2007年1月—2012年9月实施同种异体尸体肾移植的398例患者，采用原位低温灌注改良切取法取肾，进行肾移植手术。移植术后采用他克莫司（FK506）／环孢素A（CsA）＋吗替麦考酚酯（MMF）＋泼尼松（Pred）三联免疫抑制剂治疗，免疫抑制剂的剂量根据血药浓度进行调整。结果发生各种外科并发症22例，并发症发生率为5．5％。22例患者并发症发生情况：尿瘘6例，占27．3％。其中输尿管膀胱吻合VI瘘4例，占18．2％，肾盂输尿管坏死1例，占4．5％，输尿管坏死1例，占4．5％。切口及手术局部出血和血肿5例，占22．7％；动脉吻合口狭窄4例，占18．2％；切口感染3例，占13．6％；淋巴瘘2例，占9．1％；移植肾破裂1例，占4．5％；肾动脉血栓形成1例，占4．5％。结论强调修肾及移植过程中手术操作的技术要求和围手术期的精细化管理显得尤为重要。

Treatment experience of perioperative surgical complications after Cadaveric renal transplantation

Objective To explore the perioperative treatment effects and treatment experience of variety of surgical com plications of cadaveric renal transplantation. Methods Collected from January 2007 to September 2012 in our hospital 398 cases of implementation allogeneic cadaverie renal transplantation patients. In situ hypothermic perfusion improved cut emulated nephrectomy for kidney transplants. After transplantation using tacrolimus （FK506）/cyclosporine A （CsA） ＋ mycophenolate （MMF） ＋ prednisone （Pred） triple immunosuppressive therapy, Immunosuppressants dose was adjus ted based on the blood concentration. Results 22 patients with variety of surgical complications, the complication rate was 5.5%. The 22 patients with complications： urinary fistula in 6 cases, accounting for 27.3%. Ureter and bladder anastomotie fistula in 4 cases（ 18.2% ） ,ureteropelvic necrosis in 1 case（4. 5% ） ,uretera｜ necrosis in 1 case （4.5%） ~ incision and surgical local bleeding and hematoma 5 cases ,accounting for 22. 7% ; Artery anastomotic stenosis in 4 ca ses,accounting for 18.2% ; Incision infection in 3 cases, accounting for 13.6% ; Lymphatic fistula in 2 cases, accounting for 9.1% ; Renal graft rupture in l case, accounting for 4. 5 % ; Renal artery thrombosis in 1 case ,4.5 %. Conclusion The emphasis on renal and transplantation in repairing technical requirements for surgical operation and perioperative refinement management is especially important.