活体肾移植供者安全性的随访观察

摘要

目的：探讨活体肾移植对供者安全性的影响。方法研究对象为2003年4月至2007年4月在新疆医科大学第一附属医院完成活体供肾肾移植的62例供者。记录供者手术时间和住院时间，观察术后并发症发生情况和预后情况。术后随访，随访内容包括血清肌酐（Scr）、血尿素氮（BUN）、肾小球滤过率（GFR）、血浆白蛋白、血红蛋白及血压等指标，同时调查供肾对生活工作的影响。结果62例供者供肾手术均获成功。供者中1例开放取肾术中发生气胸，1例发生切口脂肪液化坏死，经对症治疗后痊愈。2例术后并发肺部感染，选用敏感抗生素及雾化吸入治疗后治愈，其余术后均恢复顺利。62例供者平均术后住院时间（8.2±2.6）d，随访时间为（3.2±1.1）年。所有供者均存活，家庭生活和日常工作也未受到明显影响。62例供者术前及术后7 d、3个月、1年、3年、5年的Scr、BUN、GFR、血浆白蛋白、血红蛋白及血压变化情况比较，差异无统计学意义（均为 P ＞0.05）。结论活体供肾肾切除手术安全可行。严格完善术前检查，术中仔细操作及术后严密随访对于保障供者的安全有十分重要的意义。%Objective To explore the influence of living donor renal transplantation on the safety of donors.Methods Sixty-two donors who underwent living donor renal transplantation in the First Affiliated Hospital of Xinjiang Medical University from April 2003 to April 2007 were selected as research objects.The operation time and length of stay of donors were recorded.The occurrence of postoperative complication and prognosis were observed.Postoperative follow up included serum creatinine (Scr),blood urea nitrogen (BUN),glomerular filtration rate (GFR),plasma albumin,hemoglobin,blood pressure and the influence of kidney donation on life and work.Results The operations of 62 donors were successful.One case developed pneumothorax during open nephrectomy and another case developed fat liquefaction and necrosis of incision.Both of them were cured after symptomatic treatment.Two cases developed pulmonary infection postoperation and were cured after the treatment of sensitive antibiotics and aerosol inhalation.The other cases recovered smoothly after operation.In 62 donors,the average postoperative length of stay was (8.2 ±2.6)d,and the follow-up time was (3.2 ±1 .1 )years.All of the donors survived without influence on life and work.No significant difference was observed in the changes of Scr,BUN,GFR,plasma albumin,hemoglobin,blood pressure of the donors before operation and 7 d,3 months,1 year,3 years,5 years after operation (all in P >0.05).Conclusions The living donor nephrectomy is safe and feasible.It is very important for assuring the safety of donors to examine living donor perfectly before operation,be careful during operation,and closely follow up after operation.