肾移植后淋巴漏的原因分析

背景：近年来,肾移植后并发症明显降低,但移植后淋巴漏仍有很多报道。目的：探讨肾移植后淋巴漏的原因。方法：分析396例肾移植患者的临床资料,根据移植中髂血管周围有无肿大淋巴结分为淋巴结肿大组（n=21）和无肿大组（n=375）,分析两组移植后淋巴漏的原因。结果与结论：两组共发生淋巴漏27例,总发生率为6.82%。淋巴结肿大组5例,发生率为23.81%,移植后3d出现淋巴漏,平均持续时间为23d,淋巴液引流量日均为191mL;无肿大组22例,发生率为5.87%,移植后8d出现淋巴漏,平均持续时间为11d,淋巴液引流量日均为96mL。两组比较差异有显著性意义（P〈0.01）。淋巴结肿大组移植后病理诊断淋巴结结核1例,出现淋巴漏1例;反应性淋巴结肿大9例,出现淋巴漏1例;慢性淋巴结炎11例,出现淋巴漏3例;无淋巴结肿大组1例移植肾功能丢失,1例死亡。说明肾移植后淋巴漏与肿大淋巴结性质、手术操作、排斥及感染等因素有关,影响人肾存活。

Cause of lymphatic leakage after renal transplantation

BACKGROUND： In recent years, the complications after renal transplantation have decreased obviously, but there have been many reports describing lymphatic leakage after transplantation. OBJECTIVE： To investigate the cause of lymphatic leakage after renal transplantation. METHODS： The clinical data of 396 cases of renal transplantation was analyzed. These patients were assigned to two groups according to lymph node swelling around the iliac vessels in transplantation： lymphadenectasis （n=21）, non-swelling group （n=375）. The causes of postoperative lymphatic leakage were analyzed. RESULTS AND CONCLUSION： Lymphatic leakage occurred in 27 cases in two groups, with an incidence rate of 6.82%. In the lymphadenectasis group, five cases presenting with lymphatic leakage, with an incidence rate of 23.81%. Lymphatic leakage occurred 3 days after transplantation, the average duration of lymphatic leakage was 23 days, and the lymph drainage was 191 mL every day. In the non-swelling group, 22 cases presented with lymphatic leakage, with an incidence rate of 5.87%. Lymphatic leakage occurred 8 days after transplantation, the average duration of lymphatic leakage was 11 days, and the lymph drainage was 96 mL every day. There were significant differences between these two groups （P 0.01）. In the lymphadenectasis group, one case suffered from lymph node tuberculosis and lymphatic leakage, nine cases suffered from reactive lymph nodes but one of them suffered from lymphatic leakage, 11 cases suffered from chronic lymphadenitis, but three cases of them suffered from lymphatic leakage. In the non-swelling group, one case presented with lost function of transplanted kidney and one case died. These findings suggest that lymphatic leakage after kidney transplantation is related to the nature of lymph nodes, operation, rejection and infection, which affect the survival of human kidney.