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肾移植术后经手术治疗的早期并发症

Surgically treated early complications after kidney transplantation.

作者信息

Król R, Cierpka L, Ziaja J, Pawlicki J, Budziński G

机构信息

Department of General and Transplant Surgery, Silesian University of Medicine, Katowice, Poland.

出版信息

Transplant Proc. 2003 Sep;35(6):2241-2. doi: 10.1016/s0041-1345(03)00769-3.

Abstract

Early surgical complications after kidney transplantation (KTx) remain important clinical problems. The 35 patients in whom forty-six complications appeared within 1 month required surgical treatment. The causes were divided into four groups: bleeding and/or hematoma of the perigraft region (n = 22); urological complications (n = 9); simultaneous bleeding and/or hematoma and urological complications (n = 6); and others (n = 9). Among the 28 cases of hemorrhagic complication, the source of bleeding was not localized during the reoperation in 53.7% cases. Vascular anastomotic leakage was confirmed only in 7.1% of patients. The most common urological complications were stricture of (46.7% cases) and leakage at (26.7%) the vesicoureteral anastomosis. Within 3 months after KTx nephrectomy was performed in 27.5% of patients who had been previously operated for surgical complications compared to 4.6% patients without interventions. Among patients with a single reoperation the graft had to be removed in 20.0% compared with 44.4% for those with multiple reoperations. Localization of the bleeding source causing an early perigraft hematoma is not always possible. The most common early urological complication is a vesicoureteral stricture caused by edema. Surgical complications that appear within 1 month after KTx increase the risk of early graft loss.

摘要

肾移植(KTx)后的早期手术并发症仍然是重要的临床问题。35例患者在1个月内出现了46种并发症,需要进行手术治疗。病因分为四组:移植肾周围区域出血和/或血肿(n = 22);泌尿系统并发症(n = 9);同时存在出血和/或血肿及泌尿系统并发症(n = 6);其他(n = 9)。在28例出血性并发症中,53.7%的病例在再次手术时出血源未定位。仅7.1%的患者证实有血管吻合口漏。最常见的泌尿系统并发症是膀胱输尿管吻合口狭窄(46.7%的病例)和漏尿(26.7%)。在KTx后3个月内,曾因手术并发症接受过手术的患者中有27.5%进行了肾切除术,而未接受干预的患者中这一比例为4.6%。在单次再次手术的患者中,20.0%的患者不得不切除移植肾,而多次再次手术的患者中这一比例为44.4%。导致早期移植肾周围血肿的出血源不一定总能定位。最常见的早期泌尿系统并发症是由水肿引起的膀胱输尿管狭窄。KTx后1个月内出现的手术并发症会增加早期移植肾丢失的风险。

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