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目的:探讨亲属活体供肾移植术后移植肾周血肿的病因及诊疗方法。方法:回顾性分析6例移植肾周血肿患者的临床表现、凝血功能及治疗情况并作文献复习。结果:6例患者均行凝血功能及移植肾彩超检查,均有不同程度的凝血功能障碍,5例彩超发现移植肾周血肿并行移植肾周血肿清除术,术后随访1～3个月,未见血肿,血肌酐78.4～123.7μmol/L。1例因血肿机化彩超漏诊,术中确诊,最后因移植肾功能延迟并凝血功能障碍导致多器官功能衰竭而死亡。结论:凝血功能障碍是导致肾移植术后移植肾周血肿的主要原因,若患者出现尿量减少、腹痛、移植肾区隆起伴胀痛等临床表现,应行移植肾彩超检查,既排除排斥反应又明确有无移植肾周血肿压迫肾脏,同时检查凝血功能。彩超可作为其首选诊断方法,必要时可考虑行CT或MRI检查,重点是积极有效地预防术前和术后凝血功能障碍。
Objective: To investigate the etiology and diagnosis and treatment of transplanted renal hematoma after living donor renal transplantation. Methods: Retrospective analysis of 6 cases of transplanted hematoma in patients with clinical manifestations, coagulation function and treatment and literature review. Results: All the 6 patients underwent coagulation tests and color Doppler ultrasound examinations of renal allografts. All of them had different degree of coagulation dysfunction. Five cases of transplanted perinephric hematoma and perinephric hematoma were found in 5 cases, followed up for 1 to 3 months See hematoma, serum creatinine 78.4 ~ 123.7μmol / L. One case was diagnosed as missed due to hematoma-based computerized color Doppler ultrasound and finally died of multiple organ failure due to delayed graft function and coagulation dysfunction. CONCLUSION: Coagulation dysfunction is the main reason leading to peri-renal hematoma after renal transplantation. If patients have clinical manifestations such as decreased urine output, abdominal pain, graft area with swelling and pain, they should be examined by transplanted renal ultrasound to exclude rejection Also clear whether the transplanted hematoma oppression of the kidneys, while checking the coagulation. Choi ultrasound as its preferred diagnostic method, if necessary, consider CT or MRI examination, the focus is actively and effectively prevent preoperative and postoperative coagulation disorders.