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目的探讨儿童肾移植的指征、手术特点,以提高手术成功率。方法1993年1月~2004年5月完成12~17岁9例儿童肾移植,原发病7例为慢性肾小球肾炎、1例为药物性(丁胺卡那霉素)肾脏损害、1例为Alport综合征。供肾获取均采用腹部多器官联合切取技术,供肾热缺血时间3~8 min,平均4.5 min,冷缺血时间5~14 h,平均8.5 h,以保证供肾质量;除1例患者经腹部供肾动脉与受者髂总动脉行端-侧吻合外,其余患者均与成人肾移植手术方式相同;围手术期甲基泼尼松(MP)用量为2 g,采用三联用药方案:环孢素A(CsA)或普乐可复(FK506)加硫唑嘌呤(AzA)或霉酚酸酯(MMF)加泼尼松(Pred)。结果所有患者肾功能均在3~12 d恢复正常(血肌酐为77~131μmol.L-1);除第1例患者肾移植术后出现供体输尿管末端缺血坏死、经再次手术后痊愈,余无其他外科并发症;2例次出现急性排斥反应,经应用MP0.5 g.d-1,3 d后逆转;Alport综合征患者1年2个月后出现蛋白尿,经治疗无明显好转,但血肌酐维持在116~172μmol.L-1之间;所有移植肾存活至少1年以上,最长存活12年。结论良好的组织配型和供体质量、恰当的手术方式及个体化的免疫抑制方案,以及术后严密监测是提高儿童肾移植手术成功率的关键。
Objective To investigate the indications and operative characteristics of children with renal transplantation in order to improve the success rate of surgery. Methods From January 1993 to May 2004, 9 children aged 12 to 17 years old underwent renal transplantation. The primary disease was chronic glomerulonephritis in 7 patients, and the other was drug-induced (amikacin) Examples are Alport syndrome. Renal access to the use of multi-organ ablation combined abdominal technique for renal warm ischemia time of 3 to 8 min, an average of 4.5 min, cold ischemia time of 5 to 14 h, an average of 8.5 h, in order to ensure the quality of the kidneys; In addition to 1 patient The other patients were the same as the adult renal transplantation operation; the amount of methylprednisone (MP) during perioperative period was 2 g, and the triple drug regimen was used: CsA or FK506 plus AzA or MMF plus Pred. Results The renal function of all patients returned to normal within 3 ~ 12 days (serum creatinine was 77 ~ 131μmol.L-1). In addition to the first case of donor ureter end-stage ischemic necrosis after renal transplantation, after reoperation, There were no other surgical complications; 2 cases of acute rejection, reversal after MP0.5 gd-1, 3 days; Alport syndrome after 1 year and 2 months of proteinuria, no significant improvement after treatment, but Serum creatinine maintained at 116 ~ 172μmol.L-1; all graft survival for at least 1 year, the longest survival of 12 years. Conclusion Good tissue matching and donor quality, appropriate surgical methods and individual immunosuppressive regimens, as well as close monitoring after surgery are the keys to improve the success rate of children with renal transplantation.