亲属活体供肾移植术后移植肾周血肿诊疗分析(附6例报告)

Analysis on Diagnosis and Treatment of Perirenal Hematoma after Living Relative Kidney Transplantation(Report of 6 Cases)

目的:探讨亲属活体供肾移植术后移植肾周血肿的病因及诊疗方法。方法:回顾性分析6例移植肾周血肿患者的临床表现、凝血功能及治疗情况并作文献复习。结果:6例患者均行凝血功能及移植肾彩超检查,均有不同程度的凝血功能障碍,5例彩超发现移植肾周血肿并行移植肾周血肿清除术,术后随访1～3个月,未见血肿,血肌酐78.4～123.7μmol/L。1例因血肿机化彩超漏诊,术中确诊,最后因移植肾功能延迟并凝血功能障碍导致多器官功能衰竭而死亡。结论:凝血功能障碍是导致肾移植术后移植肾周血肿的主要原因,若患者出现尿量减少、腹痛、移植肾区隆起伴胀痛等临床表现,应行移植肾彩超检查,既排除排斥反应又明确有无移植肾周血肿压迫肾脏,同时检查凝血功能。彩超可作为其首选诊断方法,必要时可考虑行CT或MRI检查,重点是积极有效地预防术前和术后凝血功能障碍。

Objective： To discuss the cause and treatment for perirenal hematoma after living relative kidney transplantation. Methods： Totally 6 patients had perirenal hematoma after living relative kidney transplantation. The function of blood coagulation, clinical situation and treatment for the 6 patients were retrospectively analyzed with literature review. Results：6 patients were done examination of coagulation function and color doppler ultra- sonography of transplanted renal. All of them have different degrees of coagulation disorders. 5 cases were detec- ted perirenal hematoma by color doppler ultrasonography and cleared up by emergency operation, followed up from 1 to 3 months and no recurrence have been observed, serum creatinine ranged from 78. 4 to 123.7 μmol/L. 1 case missed diagnosis by color doppler ultrasonography due to the hematoma had organized, while diagnosised in opera- tion. Finally he died of multiple organ failure resulted from delayed renal graft function combined with coagulation disorders. Conclusions：Coagulation diaorders was the main cause of postoperative perirenal hematoma in kideny transplant recipients. If the patients have clinical manifestations with reduction of urine, abdominal pain, apophy- sis of transplanted kidney section, they should been done color doppler ultrasonography to exclude rejection and to definitude whether the oppression of transplanted kidney perirenal hematoma, examine coagulation function at the same time. Color doppler ultrasonography is the preferred diagnostic method, CT or MRI examination could be considered if necessary. However, preoperative and postoperative effectively prevent the coagulation disorders should be emphasized on.