多囊肾患者保留原肾的肾移植疗效分析

Clinical study of renal transplantation in polycystic kidney patients

目的探讨多囊肾患者保留原肾的肾移植特点、手术方式及疗效。方法回顾性分析25例多囊肾患者肾移植前后原双侧肾脏体积变化以及移植肾功能恢复情况,以25例原发病为慢性肾小球肾炎肾移植患者为对照组。结果25例患者1年人/肾存活率分别为96.0%/92.0%,3年人/肾存活率为90.0%/90.0%;发生急性排斥反应7例(28.0%),移植肾失功2例(8.0%),死亡1例(4.0%);23例患者原肾脏逐渐缩小,左肾长、宽、厚由术前(20.72±4.40)cm、(14.11±2.45)cm、(9.01±1.05)cm缩小至(14.70±2.00)cm、(10.30±1.49)cm、(6.87±0.94)cm,右肾长、宽、厚由术前(20.11±2.64)cm、(15.10±2.14)cm、(9.18±0.96)cm缩小至(15.00±1.84)cm、(10.45±1.28)cm、(6.80±1.15)cm(P<0.05);23例患者移植肾功能稳定,血尿逐渐消失,术前血压(134.20±3.12)/(95.23±2.49)mm Hg(1 mm Hg=0.133 kPa),术后(128.58±2.59)/(92.34±3.40)mm Hg(P>0.05)。对照组1年人/肾存活率分别为100.0%/100.0%,3年人/肾存活率为96.0%/96.0%;发生急性排斥反应6例(24.0%),移植肾失功1例(4.0%),死亡1例(4.0%),与多囊肾组比较均P>0.05,差异无统计学意义。结论多囊肾患者肾移植,不切除原病变肾脏移植效果满意,移植后应严密观察患者移植肾功能、血尿和感染情况。

Objective To investigate the characteristics, surgical techniques and therapeutic effects of renal transplantation of polycystic kidney patients, Methods A retrospective study of 25 renal allograft transplantation patients with polycystic kidney was carried out in our center. The size of polycystic kidney, hematuria and the graft function were observed before and after operation. Another 25 kidney transplantation patients with chronic glomerulonephritis served as controls, Results In the 25 polycystic kidney patients, 1-year and 3-year patient/graft kidney survival rates were 96.0%/92, 0% and 90.0%/90.0% , respectively. Acute rejection incidence was 28. 0% （7 cases） , 2 cases （ 8. 0% ） lost graft function and 1 case （4, 0% ） died. In the 23 patients,the original kidneys shrank after operation,with the left kidneys＇ length, width,height being （20.72 ± 4.40） cm, （ 14. 11 ± 2.45） cm, （9.01 ± 1, 05 ） cm before operation and （ 14.70 ± 2.00） cm, （ 10.30 ± 1.49 ） cm, （ 6.87 ± 0.94 ） cm after operation, and the right kidneys＇ length, width, height being （20.11 ±2.64） cm, （15. 10 ±2.14） cm, （9. 18±0.96） cm before operation and （ 15.00±1.84） cm, （ 10.45 ± 1.28） cm, （ 6.80 ± 1.15 ） cm after operation, respectively （ P 〈 0.05 ）. The kidney functions were good, and the hematuria gradually disappeared. The blood pressure altered from preoperative （ 134.20 ± 3.12）/（ 95.23 ± 2.49） mm Hg （ 1 mm Hg = 0. 133 kPa） to postoperative （ 128.58 ± 2.59 ） / （ 92.34 ± 3.40 ） mm Hg（ P 〉 0.05 ）. In the controls, 1 -year and 3-year patient/graft kidney survival rates were 100.0%/100.0% and 96.0%/96.0% , respectively ; and acute rejection incidence was 24.0% （6 cases） ,1 case （4%） lost graft function and 1 case （4%） died. Compared with polycystic kidney patients, these differences were not significant （ all P 〉 0.05）. Conclusions In the polycystic kidney patients undergoing kidney transplantation without the original kidneys removed, the therapeutic effects are good. Careful monitoring of hematuria,infection and graft kidney function is needed after transplantation.