未成年人逝世后单只供肾肾移植临床研究

发布时间：2018-04-01 21:36

本文选题：肾移植　切入点：未成年人供肾　出处：《桂林医学院》2016年硕士论文

【摘要】：目的:通过分析本中心未成年人逝世后单只供肾用于成人肾移植在围手术期处理,探讨其临床效果及安全性。方法:回顾性分析了我院2007年12月至2015年8月45个未成年人逝世后案例单只供肾肾移植的临床资料。供者男23例,女22例。年龄8月~18岁(9.54±6.13)岁。45例未成年人供体均采取开放性腹腔多器官联合切取,经过获取前对供者器官功能维护,其中有4个肾脏舍弃,总共86个肾脏用于移植。受者年龄19~63岁(33.79±10.81)岁,86例均为成人受者。肾动脉吻合采取供者肾动脉-受者髂外动脉端-侧吻合或供者肾动脉-受者髂内动脉端-端吻合,肾静脉吻合采用尽可能带腔静脉与受者髂外静脉的端-侧吻合。术前、术后采用抗CD25单克隆抗体等免疫抑制诱导,术后应用改进的三联免疫抑制方案:他克莫司+吗替麦考酚酯+泼尼松(FK506+MMF+Pred)或者环孢素A+吗替麦考酚酯+泼尼松(CsA+MMF+Pred),FK506/CsA适当延迟应用并适当减少剂量,术后根据受者CYP3A5基因型、他克莫司药物浓度检测和T细胞亚群结果调整免疫抑制剂用量。根据术后受者血栓弹力图及凝血情况调整抗凝方案的治疗。结果:手术成功率100%。受者术后发生急性排斥反应7例(8.14%),药物中毒10例(11.62%),肾功能延迟恢复(DGF),21例(24.44%),尿漏4例(4.65%),术后肺部感染7例(8.14%),有2例(2.32%)患者术后围手术期出现严重肺部感染经抢救无效死亡外,其中有两例受者(供体年龄为11月和15月)因出现动脉栓塞导致切肾,其余并发症采取相应治疗措施,2~4周后肾功能恢复正常。其余患者无任何并发症,完全均顺利恢复,出院时血肌酐131.88±44.20umol/L。结论:捐献供体器官功能保护体系的建立和应用,保证器官血液灌注和氧交换对于术后移植肾功能快速恢复帮助。手术方式的改良以及术中对血管内皮的保护可以有效减少术后血管并发症的发生率。根据TEG结合凝血功能检查制定抗凝方案,围手术期做好抗凝治疗,术后出现移植肾动静脉栓塞几率小。未成年人供者体重15kg,移植肾长度6cm,年龄2岁,经严格供受者选择后采用未成年人逝世后器官捐献单只供肾是安全可行。
[Abstract]:Objective: to analyze the perioperative management of adult renal transplantation with single donor kidney after the death of a minor in our center. Methods: the clinical data of 45 cases of single donor kidney transplantation after the death of 45 minors in our hospital from December 2007 to August 2015 were analyzed retrospectively. 22 female cases. The age of 18 years was 9.54 卤6.13 years old. 45 minor donors were all treated with open abdominal multiple organ extraction. The donor organ function was maintained before acquisition, and 4 of them were abandoned. A total of 86 kidneys were used for transplantation. 86 recipients, aged 1963 years or 33.79 卤10.81 years old, were adult recipients. The anastomosis of renal artery was performed by end-to-side anastomosis of donor renal artery to recipient external iliac artery or donor renal artery to recipient internal iliac artery end-to-end anastomosis. The anastomosis of renal vein was performed by end-to-side anastomosis between vena cava and external iliac vein of recipient as far as possible. Before and after operation, immunosuppression such as monoclonal antibody against CD25 was used to induce renal vein anastomosis. The modified triple immunosuppressive regimen was used after operation: tacrolimus metoprofen prednisone FK506 MMF pred or cyclosporine A prednisone CSA MMF Predna FK506 / CSA with appropriate delayed use and appropriate dose reduction. According to the recipient's CYP3A5 genotype, Adjusts the dosage of immunosuppressant according to thromboelastogram and coagulation status of the recipient. Results: the successful rate of operation is 100%. The recipient is acute after operation, and the dosage of immunosuppressant is adjusted according to the test of tacrolimus drug concentration and the result of T cell subsets. There were 7 cases of sexual rejection, 10 cases of drug poisoning, 11 cases of drug poisoning, 21 cases of delayed recovery of renal function, 24 cases of DGFI, 4 cases of urinary leakage, 7 cases of postoperative pulmonary infection, and 2 cases of postoperative pulmonary infection. Among them, two recipients (donor age: November and 15 months) underwent renal excision due to arterial embolization. The remaining complications were treated for 2 weeks, and the renal function returned to normal after 4 weeks. The remaining patients recovered completely without any complications. Serum creatinine was 131.88 卤44.20 umol / L at discharge. Conclusion: establishment and application of donor organ function protection system, Ensuring organ blood perfusion and oxygen exchange can help to recover renal function quickly after operation. The improvement of operation method and the protection of vascular endothelium during operation can effectively reduce the incidence of postoperative vascular complications. Blood coagulation function test to establish anticoagulant program, Perioperative anticoagulant therapy was performed. The risk of graft arteriovenous embolism was small. The minor donor weighed 15 kg, the length of the transplanted kidney was 6 cm, and the age was 2 years old. It is safe and feasible to use the donor kidney only after the death of a minor.
【学位授予单位】：桂林医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R699.2

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