移植肾自发性破裂的诊治

Diagnosis and treatment of spontaneous rupture of renal transplants

目的:探讨移植肾自发性破裂的原因及防治措施。方法:回顾分析本院392例同种肾移植术后发生移植肾自发性破裂20例临床资料。结果:发生率为5.1%。14例保留肾脏成功,其中2例经保守治疗痊愈。6例肾切除者中有4例为急性排斥反应引起。结论:肾破裂的发生与排斥反应、肾缺血性损害、肾静脉引流不畅及尿路梗阻有关。对于出血量少、肾功能好者,可采用保守治疗。预防要从肾脏摘取与灌洗、植肾手术、合理应用免疫抑制剂、及早处理排斥反应等多方面着手。

Purpose:To elucidate the causes and treatment of spontaneous rupture of renal transplants.Methods:A retrospective analysis of 20 spontaneous ruptures in 392 homoplastic kidney transplantations was conducted.Results:The incidence rate of spontaneous rupture of transplant kidneys was 5.1 %.14 kidneys were saved through treatment,two of which were cured utilizing conservative treatment.Of the remaining 6 resected kidneys,4 resulted in acute rejection.Conclusions:Kidney rupture is related to transplant rejection,renal ischemia,inadequate drainage of renal veins,and urinary obstruction.Conservative treatment is optimal for patients with both relatively good renal function and who have not suffered large amounts of blood loss.Prevention should begin with the removal of the kidney,operation of the renal graft,rational use of immuno depressants,and early management of transplant rejection.