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目的探讨尸体肾移植术后围手术期多种外科并发症治疗效果和治疗经验。方法收集郑州人民医院器官移植科2007年1月—2012年9月实施同种异体尸体肾移植的398例患者,采用原位低温灌注改良切取法取肾,进行肾移植手术。移植术后采用他克莫司(FK506)/环孢素A(CsA)+吗替麦考酚酯(MMF)+泼尼松(Pred)三联免疫抑制剂治疗,免疫抑制剂的剂量根据血药浓度进行调整。结果发生各种外科并发症22例,并发症发生率为5.5%。22例患者并发症发生情况:尿瘘6例,占27.3%。其中输尿管膀胱吻合口瘘4例,占18.2%,肾盂输尿管坏死1例,占4.5%,输尿管坏死1例,占4.5%。切口及手术局部出血和血肿5例,占22.7%;动脉吻合口狭窄4例,占18.2%;切口感染3例,占13.6%;淋巴瘘2例,占9.1%;移植肾破裂1例,占4.5%;肾动脉血栓形成1例,占4.5%。结论强调修肾及移植过程中手术操作的技术要求和围手术期的精细化管理显得尤为重要。
Objective To investigate the therapeutic effect and treatment experience of various surgical complications during cadaveric renal allograft transplantation. Methods 398 patients undergoing allograft renal transplantation from January 2007 to September 2012 in Zhengzhou People’s Hospital were enrolled. The kidney was transplanted by modified hypothermia perfusion in situ and the kidney was transplanted. After transplantation, the dose of immunosuppressant was treated with FK506 / CsA + MMF + Pred triple immunosuppressant, Concentration adjustment. Results A variety of surgical complications occurred in 22 cases, the incidence of complications was 5.5%. Complications in 22 patients: urinary fistula in 6 cases, accounting for 27.3%. Among them, 4 cases of ureteric anastomotic fistula (18.2%), 1 case of ureteropelvic necrosis (4.5%) and 1 case of ureteral necrosis (4.5%). Incision and operation of local hemorrhage and hematoma in 5 cases, accounting for 22.7%; artery anastomotic stenosis in 4 cases, accounting for 18.2%; incision infection in 3 cases, accounting for 13.6%; lymphatic fistula in 2 cases, accounting for 9.1%; 4.5%; renal artery thrombosis in 1 case, accounting for 4.5%. Conclusions It is particularly important to emphasize the technical requirements for perioperative management of the kidney and its transplants and the careful perioperative management.