摘要
目的 探讨儿童肾移植适应证的选择、围手术期处理 ,以及肾移植对儿童生长发育、心理及生理上的影响。方法 回顾分析 1985年以来 18例儿童肾移植的临床资料 ,年龄 13~ 16岁 ,平均年龄 (15± 1.3)岁 ,其中 13岁 3例 ,14岁 4例 ,15岁 6例 ,16岁 5例。体重 2 2~ 4 3kg ,平均 (31±6 .4 )kg。结果 儿童肾移植占同期肾移植总例数的 1.4 % ,移植手术时间 1.5~ 3h ,无外科并发症。术后 3个月内发生急性排斥反应 5例 (2 7.8% ) ,1年人 /肾存活率为 10 0 % / 10 0 % ,3年 86 .7% /73.3% ,5年 80 .0 % / 70 .0 %。术后第 1年体重增加 6~ 10kg ,身高增高 2~ 5cm。 2例男性受者已结婚 ,1例育有一子一女 ,子女均健康。主要并发症为高血压 (44 .4 % )、白内障 (11.1% )、糖尿病(16 .7% )。死亡 2例 ,死因分别为肺部感染、肝功能损害。结论 肾移植是治疗儿童终末期肾功能衰竭的有效治疗手段。根据体重和年龄选择合适的植肾部位与血管吻合方式。环孢素A和FK5 0 6用量较成人大 ,应严密观察其血药浓度 ,激素用量宜减少。定期随访。
Objective To review the results of pediatric kidney transplantation.Methods The clinical data of 18 kidney transplant recipients performed after 1985 was analyzed retrospectively. The age ranged from 13 to 16 years (average 15± 1.3 ) and weight ranged 22~43?kg (mean 31± 6.4 ) . Results Pediatric kidney transplantation accounted for 1.4% of all kidney transplantations. Operative duration ranged from 1.5 to 3 hours. There was no surgical complication. Acute rejection occurred in 5 recipients ( 27.8% ) three months post operatively. The patient/graft survival rates were 100%/100% in one year, 86.7% / 73.3% in 3 years, and 80%/70% in 5 years respectively. The body weight of the kidney transplant recipients increased by 6~10?kg, height 2~5?cm during the first post operative year. Two male recipients married. One of them fathered a boy and a girl. The main complications included hypertension ( 44.4% ), cataract( 11.1% ) and diabetes( 16.7% ). Two recipients died of lung infection and hepatic failure. Conclusions Kidney transplantation is preferred treatment for end stage renal failure. The implantation site and type of vessel anastomosis should vary according to the body weight. Higher dose of Cyclosporin or FK506 and lower dose of prednisone are required compared to adults. The blood level of Cyclosporin and FK506 should be monitored closely. Regular followed up examination is the key to long term survival.
出处
《中华小儿外科杂志》
CSCD
北大核心
2002年第6期487-490,共4页
Chinese Journal of Pediatric Surgery