Matas A J, Simmons R L, Buselmeier T J, Najarian J S, Kjellstrand C M
Am J Surg. 1975 Jun;129(6):616-20. doi: 10.1016/0002-9610(75)90332-3.
Routine bilateral nephrectomy and splenectomy (BNS) in uremic patients before transplantation are relatively safe procedures except when there is pre-existing sepsis, diabetes, or severe hypertension. A review of 421 patients undergoing routine pretransplantation BNS reveals that death before transplantation occurs in two definable groups of patients. In our series, the first group, those with juvenile onset diabetes, have a 15.4 per cent pretransplantation mortality (9.6 per cent operative and 5.8 per cent nonoperative) while being maintained on hemodialysis and awaiting transplantation. The second group, nondiabetic patients with other preoperatively definable risk factors such as severe hypertension and infected kidneys, had a 3.25 per cent pretransplantation mortality (1.9 per cent operative and 1.25 per cent nonoperative) while on hemodialysis. Paradoxically, these same factors are used as absolute criteria for pretransplantation nephrectomy at institutions where this operation is not a routine part of the pretransplantation regimen.
对于尿毒症患者，移植前进行常规双侧肾切除术和脾切除术（BNS）相对安全，除非患者术前已存在败血症、糖尿病或严重高血压。一项对421例行常规移植前BNS患者的回顾显示，移植前死亡发生在两组可明确界定的患者中。在我们的系列研究中，第一组为青少年发病型糖尿病患者，在接受血液透析并等待移植期间，移植前死亡率为15.4%（手术死亡率9.6%，非手术死亡率5.8%）。第二组为非糖尿病患者，术前存在其他可明确界定的危险因素，如严重高血压和感染性肾脏，在接受血液透析时，移植前死亡率为3.25%（手术死亡率1.9%，非手术死亡率1.25%）。矛盾的是，在一些机构中，这些相同的因素被用作移植前肾切除术的绝对标准，而在这些机构中，该手术并非移植前方案的常规组成部分。
