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目的探讨老年终末期肾病患者施行肾移植的特点。方法对本组18例肾移植患者进行总结分析。本组年龄在60—75岁之间。原发病为“慢性肾炎,尿毒症”。术前透析时间为1—88个月。18例均伴有高血压,16例有不同程度的心衰病史,同时有不同程度的腹水,7例有心包积液,6例有胸腔积液。18例均为尸体肾移植。供、受者ABO血型完全相同。淋巴细胞毒交叉试验2—8%。术前有15例进行了PRA检测:阴性者12例,致敏者3例。HLA配型:2001年以后的6例做了HLA配型,其中5个抗原错配的1例,4个抗原错配的4例,3个抗原错配的1例。供肾热缺血时间5—8分钟,冷缺血时间4—10小时。采取供肾动脉与髂内动脉吻合6例,与髂外动脉吻合12例;供肾静脉与髂外静脉吻合;输尿管与膀胱吻合采用外隧道式。18例均放置双J管。术后采用CsA+Aza+Pred免疫抑制治疗6例,采用CsA+MMF+Pred免疫抑制治疗12例。结果本组目前人存活14例,肾存活14例,死亡4例,1年人/肾存活率:90%,术后发生急排4例,急性肾功衰竭5例,各种感染8例,其中肺部感染5例,尿路感染2例,伤口积液伴感染5例。输尿管吻合口漏1例。死亡4例中有2例死于肺部感染,1例死于术后2天急性心衰合并上消化道大出血,另外1例术后4个月死于肝癌。结论我们体会老年组的各种并发症发病率较高,尤其是心脑肺的并发症。感染的发病率也较高,尤其是肺部感染,也是肾移植术后死亡的主要原因。免疫抑制剂的用量较青年组应偏小。注意到以上几点,手术成功率并不低于青年组,而且5年存活率及生活质量明显优于透析组。因此。高龄患者并非肾移植手术禁忌症。
Objective To investigate the characteristics of renal transplantation in elderly patients with end-stage renal disease. Methods 18 cases of renal transplant patients in this group were analyzed. The group is between 60-75 years of age. Primary disease as “chronic nephritis, uremia.” Preoperative dialysis time is 1-88 months. Eighteen cases were associated with hypertension, 16 cases had different degrees of history of heart failure, with varying degrees of ascites, pericardial effusion in 7 cases and pleural effusion in 6 cases. Eighteen cases were all cadaveric kidney transplantation. Donor, recipient ABO blood type exactly the same. Lymphocyte toxicity cross test 2-8%. Preoperative 15 cases were carried out PRA test: negative in 12 cases, 3 cases of sensitization. HLA matching: HLA typing was performed in 6 cases after 2001, including 1 mismatch of 5 antigens, 4 mismatches of 4 antigens, and 1 mismatch of 3 antigens. Renal ischemia for 5-8 minutes, cold ischemia 4-10 hours. Six cases of anastomosis between the renal artery and the internal iliac artery were obtained and anastomosed with the external iliac artery in 12 cases. The renal vein was anastomosed with the external iliac vein. The anterolateral ureter and anastomosis were performed by external tunneling. 18 cases were placed double J tube. Postoperative CsA + Aza + Pred immunosuppressive therapy in 6 cases, CsA + MMF + Pred immunosuppressive therapy in 12 cases. Results In this group, 14 cases of human survival, 14 cases of renal survival, 4 cases of death, 1 year human / kidney survival rate: 90%, emergency discharge in 4 cases, acute renal failure in 5 cases, various infections in 8 cases, Of which 5 cases of lung infection, urinary tract infection in 2 cases, wound fluid with infection in 5 cases. Anastomotic leakage in ureter in 1 case. Two of the four died of pulmonary infection, one died of acute upper gastrointestinal bleeding 2 days after operation, and one died of liver cancer 4 months after the operation. Conclusions We have seen a high incidence of various complications in the elderly group, especially those of cardio-cerebral-pulmonary complications. The incidence of infection is also higher, especially in lung infections, but also the main cause of death after kidney transplantation. The amount of immunosuppressive agents should be smaller than the youth group. Noticing the above points, the success rate of surgery was not lower than that of youth group, and 5-year survival rate and quality of life were significantly better than dialysis group. therefore. Elderly patients are not kidney transplant contraindications.