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目的 分析移植肾穿刺术的临床意义及并发症 ,以促进移植肾活检术在肾移植患者中的广泛应用。方法 1 994年 1月至 2 0 0 1年 1月行肾移植术的 590例患者 ,术后常规行移植肾活检术 ,肾功能短期内急剧恶化者急诊行肾穿刺活检术。采用斜角进针负压吸引法 ,对其并发症及肾活检组织病理学改变进行了分析。结果 590例患者共行 1 2 0 0次肾穿刺术 ,穿刺成功率为 99.8% ,组织质量较好的占 81 .3 % ,光镜标本平均每份包含肾小球 (1 9.0± 9.0 )个。肾穿刺后肉眼血尿的发生率为1 .6 % ,肾周血肿的发生率为 0 .3 % ,经对症处理后缓解。出现出血并发症的患者肾组织病理学检查均有异常改变 ,包括急性肾小管坏死 (ATN) ,急性排斥反应 ,慢性排斥反应等。病情稳定患者的血清肌酐水平在肾活检后无明显的变化 .肾功能正常患者的肾活检组织病理检查发现异常的有 2 7.8% ,其中临界改变占 1 1 .9% ,动脉内膜炎占 4 .0 % ,急性排斥占 1 .4 % ,此外尚有少量的慢性排斥及间质非特异性细胞浸润。肾功能异常的患者中有 34 .9%肾组织病理表现为正常移植肾改变 ,30 .2 %的患者诊断为急性排斥 ,1 7.4 %患者诊断为临界改变 ,动脉内膜炎及ATN各占有 0 .3 %。结论 斜角进针负压吸引肾活检术在肾脏移植患者中应用成功率高 ,且较为安?
Objective To analyze the clinical significance and complications of transplanted renal biopsy in order to promote the extensive application of transplanted kidney biopsy in renal transplant patients. METHODS: From January 1994 to January 2001, 590 patients undergoing renal transplantation underwent routine renal biopsy and acute renal failure within a short period of time after performing renal biopsy. Using beveling negative needle suction method, its complications and renal biopsy histopathological changes were analyzed. Results A total of 1,200 kidney punctures were performed in 590 patients. The successful rate of puncture was 99.8%, the quality of tissue was 81.3%, and the mean number of glomeruli in glomeruli was (9.09 ± 9.0) . The incidence of gross hematuria after renal puncture was 1.6%. The incidence of perinephric hematoma was 0.3% and was relieved after symptomatic treatment. Patients with bleeding complications showed abnormal changes in renal pathology, including acute tubular necrosis (ATN), acute rejection, and chronic rejection. Patients with stable disease serum creatinine levels after renal biopsy showed no significant changes in patients with normal renal function of renal biopsy histopathological findings were abnormal 7.88%, of which critical changes accounted for 11.9%, endocarditis accounted for 4 .0%, acute rejection accounted for 1.4%, in addition to a small amount of chronic rejection and interstitial nonspecific cell infiltration. Among the patients with abnormal renal function, 34.9% of the renal tissues showed normal renal pathological changes, 30.2% of the patients were diagnosed as acute rejection, 7.4% of the patients were diagnosed as critical changes, and the endocarditis and ATN each had 0 .3%. Conclusion Oblique angle needle negative pressure to attract renal biopsy in renal transplant patients with high success rate, and more safety?