肾移植术后移植肾功能延迟恢复的处理(附14例报告).docVIP

肾移植术后移植肾功能延迟恢复的处理(附14例报告) 作者：冯振华，丁勇泉 　　【关键词】 肾移植；移植肾功能延迟恢复 　　Treatment of delayed graft function in renal transplantation (report of 14 cases) 　　Feng Zhenhua, Ding Yongquan 　　(Department of Urology, the Municipal Hospital of Gaozhou, Gaozhou 525200, China) 　　ABSTRACT: Objective To investigate the cause and treatment for delayed graft function (DGF) in renal transplantation. Methods Among 14 cases of DGF, one was diagnosed as renal vein embolism, two as nephrotoxicity caused by CsA, six as acute tubular necrosis (ATN) and five as acute rejection (AR). The diagnoses were confirmed by clinical presentation, blood creatinine, color Doppler ultrasonography, and fine needle asperation biopsy (FNAB), etc. All cases were individually treated with hemodialysis, surgical exploration and the adjustment of immunosuppressant. Results In 13 cases, urinary output has been increased 9 to 27 days after the operation and renal function recovered one month after operation. One case underwent nephrectomy because of renal venous embolism. Conclusion The cause of DGF included surgical complications, nephrotoxicity caused by CsA, ATN and AR. It should be diagnosed early on clinical presentation and assistant examination, and treated with hemodialysis, surgical exploration and the adjustment of immunosuppressant with satisfactory results. 　　KEY WORDS: renal transplantation; delayed graft function 　　摘要：目的 探讨肾移植术后移植肾功能延迟恢复(DGF)的原因及处理措施。方法 通过对发生DGF的14例患者临床表现、血肌酐、环孢素A(CsA)血浓度、彩色多普勒超声、移植肾细针穿刺吸抽细胞学检查(FNAB)等分析，诊断移植肾静脉栓塞1例，CsA中毒性肾损害2例，急性肾小管坏死(ATN)6例，急性排斥反应(AR)5例。分别予血液透析、手术探查、调整免疫抑制剂种类或剂量等处理。结果 1例移植肾静脉栓塞患者行移植肾切除术；13例患者9-27d尿量增多，术后1个月复查肾功能良好。结论 DGF原因包括技术性并发症、CsA中毒性肾损害、ATN、排斥反应等，应结合临床表现及辅助检查，早期诊断，及早采取血液透析、手术探查、调整免疫抑制剂种类或剂量等措施，可取得良好效果。 　　关键词：肾移植；移植肾功能延迟恢复 　　我院自2001年6月至2005年11月，共行肾移植术85例，包括活体亲属供肾移植24例，其中14例术后出现移植肾功能延迟恢复(DGF)。根据其原因，我们采取了不同的处理措施，取得了满意的效果，现报告如下。 　　1 资料与方法 　　1.1 临床资料 本组14例，男11例，女3例，年龄23-65岁。其中尸体肾移植12例，活体亲属供肾移植2例。原发病慢性肾小球肾炎13例，多囊肾1例。