移植肾间隔室综合征的临床诊断与防治

Diagnosis,Prevention and Therapy for Renal Allograft Compartment Syndrome

目的探讨移植肾间隔室综合征的临床诊断与防治。方法收集华中科技大学同济医学院附属同济医院器官移植研究所2004年7月至2008年4月肾移植术后发生移植肾间隔室综合征的17例病例,回顾分析其发生影响因素、临床特点及治疗措施。结果17例患者均因移植肾周压力升高,压迫移植物而出现尿量减少以至无尿。其中1例发生移植肾动脉栓塞而被迫切除移植肾;3例经积极针对病因处理,移植肾压力降低后肾功能迅速恢复;余13例经5~18次血透后,肾功能均逐渐恢复正常。结论移植肾间隔室综合征作为移植肾功能恢复延迟的一种特殊类型并不罕见,可影响患者恢复。对高危人群早期诊断、及早针对病因进行治疗是有效减少此类并发症的关键。

Objective To investigate the clinical diagnosis,prevention and therapies for renal allograft compartment syndrome（RACS）.Methods Seventeen recipients who underwent a renal transplantation at our center between July 2004 and April 2008 developed RACS early in the postoperative period.The related factors,clinical characteristics and therapies of RACS were analyzed retrospectively.Results All seventeen patients developed to the reduced urine output,even anuria,because of the increased retroperitoneal pressure.One of them was forced to remove the allograft for thrombosis of renal artery.Three patients were treated positively to aim at the cause of disease,and the allograft function was improved dramatically following renal allograft decompression.In the remaining 13 patients,the allograft function was recovered gradually after hemodialysis of 5 to 18 times.Conclusion As a particular type of delayed renal graft function,RACS is not rare,and will influence the recovery of kidney recipients.The key to reduce this kind of complication is early diagnosis to high risk group and therapy to aim directly at etiological factors.