多囊肾尿毒症患者肾移植时同期切除多囊肾的临床分析

目的 探讨多囊肾尿毒症患者在接受肾移植时是否同期切除多囊肾以及切肾对肾移植手术、术后并发症及患者预后的影响.方法 对63例接受肾移植治疗的多囊肾患者的临床资料进行回顾性分析.63例中,合并多囊肝者43例,胰腺囊肿者2例.对多囊肾体积较大影响手术操作、术前曾有血尿或泌尿系感染的31例患者,在肾移植的同时切除患者的多囊肾(切肾组),另32例保留多囊肾,仅行肾移植(保留组).术后采用环孢素A(或他克莫司)、霉酚酸酯和泼尼松预防排斥反应,观察比较两组患者的一般情况、移植肾功能恢复延迟(DGF)发生率、急性排斥反应发生率、手术并发症发生率、术后感染情况、患者和移植肾存活率等指标.结果 切肾组的手术耗时为(300±31)min,肾周引流管持续时间为(4.6±1.4)d,明显长于保留组(P＜0.01,P＜0.01),红细胞输注量为(4.31±1.05)U,明显多于保留组(P＜0.01).切肾组手术并发症发生率为29.0%(9/31),明显高于保留组的6.2%(2/32),差异有统计学意义(P＜0.05).保留组泌尿系感染发生率为31.2%(10/32),而切肾组只有6.5%(2/31),二者间比较,差异有统计学意义(P＜0.05),保留组因术后多囊肾感染而须再次手术切除多囊肾者占12.5%(4/32).切肾组和保留组术前各有24例血压偏高,切肾组术后8例(33.3%)血压恢复正常,而保留组只有2例(8.3%)血压恢复正常,两组间的差异有统计学意义(P＜0.05).两组在DGF发生率和急性排斥反应发生率、人/肾1年和5年存活率等方面的差异均无统计学意义.结论 只要操作细致,多囊肾患者接受肾移植时同期切除多囊肾是安全的,但切肾与否与人/肾存活率无关.

The clinical analysis about surgical excision of polycystic kidney during kidney transplantation in uremic patients

Objective To investigate the merit and demerit for surgical excision of polycystic kidney at the same time of kidney transplantation and to analyze its effect on complications and prognosis.Methods The data of 63 cases of polycystic kidney were retrospectively analyzed.Among the 63 recipients,43 recipients were combined with polycystic liver,and 2 with pancreatic cyst.For the large size of polycystic kidney,in 31 patients with hematuria or urinary tract infection,the polycystic kidney was resected during kidney transplantation(kidney-cut group,31 cases).The polycystic kidneys in The remaining 32 cases were preserved during kidney transplantation (reservation group).All the recipients were treated with CsA(Tacrolimus),mycophenolate mofetil (MMF)and prednisone after transplantation.The general conditions of recipients,the occurrence of delayed graft function(DGF),acute graft rejection.operative complications and infection,and survival rate of recipients and grafts were observed.Results Operative time in kidney-cut group was (300±31)min,and perirenal drainage tube duration was(4.6±1.4)days in kidney-cut group,significantly longer than in reservation group(both P＜0.01).Volume of red blood cells transfusion in kidney-cut group was(4.31±1.05)U,significantly more than reservation group(P＜0.01).29.0%(9/31)recipients in kidney-cut group had surgical complications,significantly higher than reservation group(6.2 0A,2/32)(P＜0.05).The ineidence of urinary tract irdection was 31.2% (10/32)in reservation group,significantly higher than in kidney-cut group(6.5%,2/31,P＜0.05).12.5%(4/32)patients in reservation group needed surgical excision of polycystic kidney after kidney transplantation due to polycystic kidney infection.In 24 recipients with preoperative high blood pressure in each group,the blood pressure of 8 recipients(33.3%)in kidney-cut group returned to normal,compared with only 2 recipients(8.3%)in reservation group(P＜0.05).The incidence of DGF,incidence of acute rejection,human/kidney 1-and 5-year survival rate between 2 groups had no statistically significant difference.Conclusion As long as the detailed operation.it is safe to resect patient's polycystic kidney during renal transplantation,but there are no effects on patient/kidney survival rate.