Chang Edward I, Galvez Michael G, Padilla Benjamin E, Freise Christopher E, Foster Robert D, Hoffman William Y
Department of Surgery, University of California, San Francisco, 94143-0932, USA.
Arch Surg. 2011 Jan;146(1):21-5. doi: 10.1001/archsurg.2010.305.
Repair of incisional hernias in renal transplant recipients is compromised because of immunosuppressive therapy.
Retrospective review.
University tertiary care institution.
Forty-two recipients of renal transplants or combined renal-pancreas transplants who underwent incisional herniorrhaphy were included in our study.
Incisional herniorrhaphy.
Postoperative complications and recurrence of incisional hernia.
Forty-two patients (mean age, 49.6 years) underwent incisional herniorrhaphy (mean area, 99.9 cm(2)) following renal transplantation (26 cadaveric donor renal, 12 combined renal-pancreas, and 4 living related donor renal) from January 1, 1995, to December 31, 2005. Using various techniques, hernia repairs were performed on average 36.4 months following transplantation. Diabetes mellitus was a frequent cause of end-stage renal disease (16 patients), followed by polycystic kidney disease (6 patients), focal segmental glomerular sclerosis (3 patients), hypertension (2 patients), Alport syndrome (2 patients), and IgA nephropathy (2 patients), with 11 patients having lupus or glomerulonephritis. Four patients developed cellulitis, 2 patients required mesh removal, and 1 patient was admitted for abscess drainage and intravenous antibiotics. Fourteen patients had recurrence of incisional hernias, with 3 patients experiencing 2 recurrences and 1 patient experiencing 4 recurrences.
To our knowledge, this is the largest series of incisional herniorrhaphies performed among patients following renal transplantation. Although smoking history, the presence of diabetes, and immunosuppressive therapy were not associated with the initial development of an incisional hernia, they were associated with complications. Component separation performed by transplant and plastic and reconstructive surgeons should be considered in the setting of recurrent hernias and large defects.
由于免疫抑制治疗，肾移植受者切口疝的修复受到影响。
回顾性研究。
大学三级医疗机构。
42例接受肾移植或肾 - 胰联合移植并接受切口疝修补术的受者纳入我们的研究。
切口疝修补术。
术后并发症及切口疝复发情况。
1995年1月1日至2005年12月31日期间，42例患者（平均年龄49.6岁）在肾移植后（26例尸体供肾肾移植、12例肾 - 胰联合移植、4例亲属活体供肾肾移植）接受了切口疝修补术（平均面积99.9 cm²）。采用多种技术，平均在移植后36.4个月进行疝修补。糖尿病是终末期肾病的常见病因（16例患者），其次是多囊肾病（6例患者）、局灶节段性肾小球硬化（3例患者）、高血压（2例患者）、奥尔波特综合征（2例患者）和IgA肾病（2例患者），11例患者患有狼疮或肾小球肾炎。4例患者发生蜂窝织炎，2例患者需要取出补片，1例患者因脓肿引流和静脉使用抗生素入院。14例患者切口疝复发，3例患者复发2次，1例患者复发4次。
据我们所知，这是肾移植患者中进行的最大系列的切口疝修补术。尽管吸烟史、糖尿病的存在和免疫抑制治疗与切口疝的初始发生无关，但它们与并发症有关。对于复发性疝和大的缺损，移植外科医生以及整形和重建外科医生进行的成分分离术应予以考虑。
