老龄亲属活体供肾移植疗效观察

目的:探讨老龄亲属活体供肾移植的疗效. 方法:我院自2006年1月至2006年12月共施行亲属活体肾移植74例,收集该74例活体供肾移植的临床资料,按供者年龄大小分为2组:老龄组(≥55岁)11例,低龄组(＜55岁)63例.分别对两组受体术后不同时间点临床资料和两组供体术前术后的临床资料进行分析比较,探讨老龄活体供肾移植的疗效. 结果:(1)受者情况:老龄组有1例术后发生移植肾功能延迟恢复,低龄组有7例,组间比较无差别(P>0.05),两组受者移植术后肾功能恢复情况比较无差异,1年人/肾存活率均为100%.供者情况:两组供者术后一周血肌酐均明显升高,老龄组术前血肌酐(85.6±13.7)μmol/L,术后1周升高至(106.4±15.6)μmol/L,而低龄供者术前血肌酐(73.7±6.8)μmol/L,术后1周升高至(101.8±13.1)μmol/L.但术后1年随访,两组供者血肌酐恢复术前水平. 结论:在严格供体筛查的前提下,老龄供肾(55～65岁)对供者是安全的;而对受者,接受老龄供肾术后近期肾功能恢复情况良好,远期效果有待进一步观察.华中科技大学同济医学院附属同济医院器官移植研究所,教育部/卫生部器官移植重点实验室 (武汉,430030)     

移植肾间室综合征四例报道

目的 探讨移植肾间室综合征的诊断方法和处理原则.方法 分析和总结4例患者发生移植肾问室综合征的危险因素以及诊断和处理方法.结果 2例由于腹胀,1例由于腰骶部挚起,1例南于再次肾移植盆腔容积狭小,腹壁张力增高而导致腹膜后压力升高,压迫移植肾,引起移植肾血液循环障碍,导致移植肾功能紊乱.彩色多普勒超声检查提示移植.肾皮质血流减少,移植肾各级动脉血流速度降低和阻力指数增高.经迅速解除引起腹膜后压力升高的危险因素,减轻腹膜后的压力,改善移植肾微循环,4例移植肾室综合征患者的肾功能均恢复正常.结论 移植肾间室综合征是肾移植术后的一种近期并发症.彩色多普勒超声检查可明确诊断;确诊后应紧急减轻腹膜后的压力,解除移植.肾受压可改善患者的预后.     

RNA干扰Caspase-3基因抑制大鼠肝脏缺血再灌注损伤

目的 观察RNA干扰(RNAi)Caspase-3基因对大鼠肝脏缺血再灌注损伤(IRI)的保护作用.方法 构建针对大鼠Caspase-3基因的短发夹状RNA(shRNA)真核表达载体.肝脏IRI前48 h经门静脉注射磷酸盐缓冲液(PBS)或Caspase-3 shRNA,实验随机分为3组,假手术组、PBS组和shRNA组.阻断大鼠70%入肝血流40 min,再灌注6,12,24 h,3,5,7 d检测血清谷丙转氨酶(ALT)和谷草转氨酶(AST)水平,肝组织Caspase-3 mRNA的表达,细胞凋亡情况,丙二醛(MDA)以及超氧化物歧化酶(SOD)的含量.结果 与PBS组比较,shRNA组再灌注6,12,24 h血清ALT和AST水平显著降低(P<0.05),shRNA组大鼠肝组织的Caspase-3 mRNA水平、肝细胞凋亡指数(25.21%±3.18%vs 35.24%±2.33%,P<0.05)和肝组织中MDA含量[(96.3±12.8)nmol/mg vs(133.5±12.4)nmol/mg,(P<0.05)]显著降低,SOD活性显著升高[(22.5±3.4)U/mg vs(12.2±3.1)U/mg,(P<0.05)].结论 RNA干扰Caspase-3基因可以抑制细胞凋亡的发生,保护肝脏缺血再灌注损伤.     

肾移植术后免疫抑制剂的选择

肾移植术后，为了预防可能发生的排斥反应，医生会选用各种免疫抑制剂以抑制人体的自身免疫力。在移植术后近期，免疫抑制剂方案的选择是否适当，在很大程度上将影响移植受者的人、肾存活。由于免疫抑制剂方案的选择完全遵循个体化治疗的原则，因此，如何选择合适的免疫抑制剂方案是每个移植医生必须面对的一大课题。各种免疫抑制剂方案的选择要基于以下两个大的方面：①疗效最佳、副作用最小，避免因免疫抑制过度导致感染、其他脏器功能损害等；②药物之间的相互作用。本文就临床常见免疫抑制剂的应用，浅谈一己之见，旨在抛砖引玉。     

桥式背驮式肝移植治疗布加综合征:附六例次临床病例分析

目的探讨肝移植治疗布加综合征的外科新技术。方法1999年以来笔者共为6例布加综合征病人施行了桥式背驮式肝移植,通过血管架桥将供肝的肝上下腔静脉与受者的右心房吻合,供肝的肝下下腔静脉与受者的下腔静脉吻合。结果6例次肝移植术均获成功,未发生手术技术并发症。其中1例术后3个月死于多器官功能衰竭,其他5例仍在随访中,1例已存活近7年,术后均未出现布加综合征复发。结论桥式背驮式肝移植为临床治疗布加综合征提供了一种新的技术途径,减少了技术并发症和布加综合征复发可能。     

结缔组织生长因子诱导人肾小管上皮细胞向间充质细胞转化的实验研究

Objective To investigate the role of connective tissue growth factor ( CTGF) in epithelial mesenchymal transition of HK-2 cells in vitro.Methods HK-2 cells were randomly divided into two groups; (1) control group including cells cultured in DMEM medium supplemented with 10% fetal bovine serum only; and (2) experimental group including cells cultured in DMEM medium supplemented with 10% fetal bovine serum and recombinant CTGF at a final concentration of 5 p-g/L The cells were collected at 72 h time points.Direct immunoiluorescence staining and immunohistochemistry were used to evaluate the E-cadherin,Vimentin,α-SMA and ERK2 in cells.Western-blotting was used to detect the E-cadherin,Vimentin and ERK2 protein expression.Boyden Chamber was used to detect the migration of tubular endothelium at 1 d,3 d and S d.Results There were less E-cadherin but more Vimentin expressed in cells of the experimental group.The presence of α-SMA was detected at 48 h with peak at 72 h in the cells of the experimental group.On the first day,the cellular migration in the two groups showed no difference.However,after 3 days,the transformed cells migrated surpassed the control group with peak at the 5th day [ (45.0±1.1) : (14.0±1.2),P < 0.05 ) ].Conclusion Connective tissue growth factor induces mesenchymal transformation of HK-2 cells,in which the ERK2 signaling pathway may play an important role.     

结缔组织生长因子诱导人肾小管上皮细胞向间充质细胞转化的实验研究

Objective To investigate the role of connective tissue growth factor ( CTGF) in epithelial mesenchymal transition of HK-2 cells in vitro.Methods HK-2 cells were randomly divided into two groups; (1) control group including cells cultured in DMEM medium supplemented with 10% fetal bovine serum only; and (2) experimental group including cells cultured in DMEM medium supplemented with 10% fetal bovine serum and recombinant CTGF at a final concentration of 5 p-g/L The cells were collected at 72 h time points.Direct immunoiluorescence staining and immunohistochemistry were used to evaluate the E-cadherin,Vimentin,α-SMA and ERK2 in cells.Western-blotting was used to detect the E-cadherin,Vimentin and ERK2 protein expression.Boyden Chamber was used to detect the migration of tubular endothelium at 1 d,3 d and S d.Results There were less E-cadherin but more Vimentin expressed in cells of the experimental group.The presence of α-SMA was detected at 48 h with peak at 72 h in the cells of the experimental group.On the first day,the cellular migration in the two groups showed no difference.However,after 3 days,the transformed cells migrated surpassed the control group with peak at the 5th day [ (45.0±1.1) : (14.0±1.2),P < 0.05 ) ].Conclusion Connective tissue growth factor induces mesenchymal transformation of HK-2 cells,in which the ERK2 signaling pathway may play an important role.     

彩色多普勒超声造影在肝移植术的应用

随着超声对比剂与造影技术迅速发展,超声造影在临床的应用日见深入,不少研究报道了其在肝移植术方面的应用。本文将以Levovist超声对比剂为例,对超声造影在肝移植术前检查和术后血管并发症的应用价值作一综述。超声造影的价值及意义超声造影(contrast ultrasonography)是将具有     

32例胰、肾同期联合移植的近期疗效

目的报告32例胰、肾同期联合移植(SPK)的近期结果及经验。方法为合并尿毒症的27例1型糖尿病和5例2型糖尿病患者施行SPK,其中胰液膀胱引流(BD)术式2例,改进的胰液空肠引流(ED)术式30例。术后早期采用他克莫司、霉酚酸酯及皮质激素预防排斥反应,同时以抗淋巴细胞球蛋白或抗CD25单克隆抗体诱导治疗。结果32例手术均获得成功,术后随访2～12个月,1例术后9周死于肺部感染,死亡时肾功能正常,另1例术后6个月死于急性心肌梗死,死亡时移植胰、肾功能正常,其余患者目前仍存活;术后(12.7±8.1)d空腹血糖恢复正常,(8.3±4.5)d停用胰岛素,(8.4±7.8)d血肌酐恢复正常。术后发生手术相关并发症有出血、移植胰切口感染、上消化道出血、右股静脉血栓形成和淋巴漏;其它并发症有药物不良反应、肺部感染,采用BD术式者并发代谢性酸中毒和镜下血尿;4例发生移植肾急性排斥反应,均经活检证实。结论SPK治疗糖尿病并发尿毒症的近期疗效满意,ED术式更符合正常生理。     

肝脏恶性肿瘤右前段(Ⅴ段和Ⅷ殷)切除术的个人经验

众多的肝切除术中,肝右前段切除或许是最困难的,因为两个切除平面必须避开两条穿越的主肝静脉。据悉,此类手术仅有3篇报道,但有关文献对临床和外科技术方面均未作详细描述。在过去11年中,作者为17例患肝恶性肿瘤的病人施行了右前段切除术,这些病人的手术情况和临床资料报告如下。