移植肾切除适应证的选择和围手术期处理

Kidney transplant nephrectomy: indication and perioperative management

为了更好地提高移植肾切除的效果，报告１９８６～１９９６年失功移植肾切除６４例，切除率为２１．６％，术后并发症发生率１８．８％，死亡率９．４％。结论：移植肾切除术较单纯肾切除复杂、危险，应严格掌握中后期失功移植肾切除指征，术前应充分透析，积极的支持疗法，改善全身状况，调整免疫抑制剂，采取合理的切肾技术，术后应密切观察各项生命体征的变化。

Kidney transplant nephrectomy has been carried out for 64 patients, the nephrectomy rate of nonfunction transplants being 21.6%. Postoperative complications occurred in 18.8% and 6 of the patients died of heart failure, respiratory infection or peptic hemorrhage. Renal allograft nephrectomy was considered as a high risk operation and the indication should be limited to uncontrolled infection, severe hematuria, persistant fever, apparently enlarged and painful allograft or refractory hypertension. The perioperative management included sufficient preoperative hemodialysis, adjustment of immunosupressives, adoption of appropriate surgical technique and close monitoring of vital signs.