肾移植术后围手术期出血诊断及治疗.doc

肾移植术后围手术期出血诊断及治疗【摘要】 目的 探讨肾移植术后围手术期出血的原因、诊断与治疗。方法 回顾性的分析23例肾移植患者的临床资料。根据出血原因分为①移植肾破裂;②移植肾动脉出血;③移植肾静脉出血;④其他原因出血。分析了引起出血的因素、诊断、治疗和预防措施。结果 本组出血患者23例,均进行了手术。1例移植肾破裂、1例肾动脉破裂因无法修补而切除移植肾;2例移植肾破裂术后死亡;2例髂外静脉窦破裂,修补术中移植肾二次再灌注,术后移植肾功能延迟恢复;其余患者移植肾功能均正常恢复。结论 肾移植术后围手术期出血的患者,应及时手术,并对不同原因的出血采用不同的手术方式。 【关键词】 肾移植;围手术期出血;诊断;手术 Diagnosis and treatment of Perioperative bleeding in kidney transplantation LIU Yong-sheng,YIN Shu-jun,SUN Qiang,et al.Department of Urology,The seventh hospital of Zhengzhou,Henan 450006,China 【Abstract】 Objective To investigate the causes,diagnosis and treatment of perioperative bleeding in kidney transplantation.Methods The clinical materials of 23 cases patients in kidney transplantation were analyzed retrospectively.The causes of bleeding were classified as follows:①rupture of allograft; ②allograft artery hemorrhage; ③kidney vein bleeding; ④other causes of bleeding.Causes,diagnosis,treatment and precautions were analyzed.Results 23 cases patients of bleeding in this group are all treated with operation.One case of allograft rupture and one case of artery rupture were carried out with allograft resection because of serious damage; two cases of vein sinus rupture were carried out with repair and second perfusion.DGF(delayed graft function) were occurred in this two patients; others patients recovered with normal allograft function.Conclusion The patients of perioperative bleeding in kidney transplantation should be carried out with different operations in time according to the different causes of hemorrhage. 【Key words】Kidney transplantation; Perioperative bleeding; Diagnosis; Operation 肾移植是治疗终末期肾脏疾病的有效方法,已广泛应用于临床。肾移植术后围手术期出血为常见并发症之一,减少肾移植术后围手术期出血则可提高患者的生存率。为此我们收集了2002年1月份至2009年12月份肾移植术后围手术期出血23例患者的临床资料,对其诊断和治疗方法进行了回顾性分析,以期提高诊疗水平。现将治疗情况报告如下。 1 资料与方法 1.1 一般资料 本组病例23例,男15例,女8例,年龄14~70岁,平均35.2岁。其中2次肾移植手术5例。手术方法:常规将移植肾置于髂窝,移植肾动静脉分别与髂外动静脉行端侧吻合,移植肾输尿管与受者膀胱行隧道式吻合。若供肾为右肾,肾静脉较短,则将供体下腔静脉给以整形,延长右肾静脉 。术后服药:规律应用免疫抑制剂。组织配型:ABO血型相符,群体反应抗体(PRA)均阴性,淋巴细胞