移植肾破裂的处理

目的　提高移植肾破裂的防治水平。方法　 6例移植肾破裂 ,手术前 2例 ,手术后 4例。 2例术前供肾破裂 ,采用切开移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾。 1例术后移植肾破裂早期 ,出血少 ,针对顽固性高血压采用“硝普钠”降压 ,配合常规抗排斥药物。 3例术后移植肾破裂出血量估计超过 10 0 0ml者 ,采用手术延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾。结果　 ( 1)手术前 2例手术后 4例 ,采用切开或者延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾并配合“硝普钠”降压的方法处理 ,均未再破裂出血 ,移植肾功能恢复良好。 ( 2 ) 1例术后移植肾破裂早期的患者 ,针对顽固性高血压采用“硝普钠”降压 ,配合常规抗排斥药物 ,非手术治疗成功。结论　 ( 1)采用手术切开或延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾可以有效治疗移植肾破裂。 ( 2 )移植肾破裂出血少的情况下 ,可以在密切观察下非手术治疗

Therapy of Transplanted Renal Rupture

Objective To improve the prevention and therapy level of transplanted renal rupture. Methods In 6 cases of transplanted renal rupture,2 cases were occurred before transplantation,and the other 4 cases were after transplantation.The ruptured envelope incision of transplanted renal+gelatin sponge filled up in the clef+catgut suture+catgut woven renal pocke to contracting and protecting transplanted renal were used in the 2 cases of donator renal rupture before transplantation.In earlier period of 1 case of transplanted renal rupture after transplantation,the hemorrhage volume was not much, and “sodium nitroprusside”was applied to treat intractable hypertension,meanwhile the routine antirejection drugs were used.The hemorrhage volume were more than 1 000 ml during short term in 3 cases of transplanted renal rupture after transplantation,and the ruptured envelope incision of transplanted renal +gelatin sponge filled up in the cleft+catgut suture+catgut woven renal pocke to contracting and protecting transplanted renal were used.Results (1) In the 2 cases before operation and 4 cases after operation, the method of ruptured envelope incision or enlongation of transplanted renal+gelatin sponge filled up in the cleft+catgut suture+catgut woven renal pocke to contracting and protecting transplanted renal and in the meantime“sodium nitroprusside”was applied to treat intractable hypertension were adopted,there were no renal rupture and hemorrhage once more, and the renal function restored well.(2) In earlier period of 1 case of transplanted renal rupture after transplantation,the“sodium nitroprusside”was applied to treat intractable hypertension, meanwhile the routine antirejection drugs were used,and conservative treatments were successful.Conclusion (1)The method of rutured envelope incision or enlongation of transplantedrenal+gelation sponge filled up in the cleft+catgut suture+catgut woven renal pocke to contracting and protecting transplanted renal is effective in the therapy of transplanted renal rupture.(2) If the hemorrhage volume is not more,the conservative treatrnents can be adopted and in the meantine the patient must be under closd surveillance.