發(fā)布時(shí)間：2018-04-05 14:16

  本文選題：邊緣供腎　切入點(diǎn)：親屬活體腎移植　出處：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景隨著外科技術(shù)的提高、移植免疫基礎(chǔ)研究的進(jìn)展以及新型免疫抑制劑的不斷問(wèn)世,腎移植已成為終末期腎病(end-stage renal disease,ESRD)患者的最佳替代治療方法。自1954年首例腎移植手術(shù)在人體成功開(kāi)展至今,腎移植已經(jīng)挽救了無(wú)數(shù)ESRD患者的生命。隨著供腎來(lái)源的短缺與等待腎移植患者人數(shù)不斷增加的矛盾日益加劇,親屬活體腎移植已成為解決供腎來(lái)源短缺的重要途徑之一。據(jù)不完全統(tǒng)計(jì),每年我國(guó)腎移植數(shù)7000~8000例次,其中活體腎移植約占20%左右,但與世界發(fā)達(dá)國(guó)家活體腎移植相比差距仍然較大。除受經(jīng)濟(jì)狀況及傳統(tǒng)觀念等的影響外,嚴(yán)格的供體篩選標(biāo)準(zhǔn),將患有腎臟或非腎臟良性疾病以及受年齡偏大等一系列問(wèn)題影響的供體排除在外,從而造成供腎資源的浪費(fèi)。因此如何合理安全地利用這類(lèi)邊緣供體,從而有效緩解活體供腎短缺的矛盾,越來(lái)越受到人們的關(guān)注。目的探討邊緣供腎在嚴(yán)格控制篩選標(biāo)準(zhǔn)后,在親屬活體腎移植中應(yīng)用的臨床效果,為臨床工作者提供有利的選擇依據(jù)。方法隨機(jī)選擇2012年1月1日至2014年3月1日鄭州人民醫(yī)院器官移植中心施行親屬活體腎移植手術(shù)的受者200例。根據(jù)供體情況,分為邊緣供腎組與標(biāo)準(zhǔn)供腎組。將邊緣供腎組設(shè)為研究組,共60例。將標(biāo)準(zhǔn)供腎組設(shè)為對(duì)照組,共140例。研究組中供體年齡≥60歲18例;肥胖供體(BMI≥28kg/m2)10例;高血壓供體10例;糖尿病供體8例;供腎動(dòng)脈輕中度狹窄10例,,病變部位均位于腎動(dòng)脈起始部;供腎合并結(jié)石2例,結(jié)石直徑分別為2mm、4mm;供腎合并囊腫2例,囊腫直徑分別為10mm、15mm。規(guī)律隨訪36m,對(duì)兩組受體臨床資料進(jìn)行回顧性分析。比較兩組受體腎移植術(shù)后1周、1、3、6、12、24、36個(gè)月腎小球?yàn)V過(guò)率估計(jì)值(glomerular filtration rate estimates,e GFR),術(shù)后肝功能異常,急性排斥反應(yīng),移植腎功能恢復(fù)延遲(delayed graft function,DGF),肺部感染,外科并發(fā)癥等術(shù)后并發(fā)癥的發(fā)生率,以及1年、3年人/移植腎生存率情況。結(jié)果研究組中受體術(shù)后各個(gè)隨訪點(diǎn)e GFR水平均低于對(duì)照組。受體術(shù)后1周e GFR水平與對(duì)照組相比,差異具有統(tǒng)計(jì)學(xué)意義(t=1.762,P0.05)。研究組受體術(shù)后1、3、6、12、24、36個(gè)月e GFR水平與對(duì)照組受體相比,差異不具有統(tǒng)計(jì)學(xué)意義(t=1.143、P0.05,t=1.281、P0.05,t=1.681、P0.05,t=1.262、P0.05,t=1.131、P0.05,t=1.331、P0.05);研究組受體與對(duì)照組受體術(shù)后1年、3年生存率分別為98.3%/100%、94.9%/98.6%,兩組相比差異均無(wú)統(tǒng)計(jì)學(xué)意義(χ2=2.311、P0.05,χ2=2.234、P0.05)。研究組受體與對(duì)照組受體術(shù)后移植腎1年、3年生存率分別為98.3%/99.3%、91.6%/96.4%,兩組相比差異均無(wú)統(tǒng)計(jì)學(xué)意義(χ2=2.946、P0.05,χ2=2.017、P0.05);研究組受體與對(duì)照組受體術(shù)后肝功能損害、急性排斥反應(yīng)、DGF、肺部感染、外科并發(fā)癥發(fā)生率方面,兩組相比差異均無(wú)統(tǒng)計(jì)學(xué)意義(χ2=1.159、P0.05,χ2=1.685、P0.05,χ2=2.681、P0.05,χ2=1.184、P0.05,χ2=1.492、P0.05)。結(jié)論邊緣供腎受體術(shù)后早期臨床效果是理想的,但應(yīng)嚴(yán)格控制其納入的標(biāo)準(zhǔn)。邊緣供腎對(duì)于受體長(zhǎng)期移植腎功能的影響,尚需要繼續(xù)觀察。在當(dāng)前供腎需求緊張的情況下,邊緣供腎可選擇性的作為擴(kuò)大活體供腎來(lái)源的有效途徑之一。
[Abstract]:Background: with the improvement of surgical technique, the progress of basic research on transplantation immunity and novel immunosuppressive agents have been developed, kidney transplantation has become the end-stage renal disease (end-stage renal, disease, ESRD) the best alternative treatment for the patients with renal transplantation. Since 1954, the first in the human body successfully carried out so far, kidney transplantation has saved countless patients with ESRD life. With the contradiction between the shortage of donor kidney from renal transplant patients and wait for the increasing number of growing, living related kidney transplantation has become one of the important ways to solve the shortage of donor sources. According to incomplete statistics, China's annual number of 7000~8000 cases of renal transplantation, the living donor kidney transplantation accounted for about 20%, but with the world developed countries living kidney transplantation compared to the gap is still large. In addition to the economic situation and the traditional concept of the donor, the strict screening criteria, the kidney or kidney Benign disease and donor age affected by a series of problems such as excluded, resulting in kidney wasting. So how to reasonable and safe use of this type of marginal donor, so as to effectively alleviate the contradiction between the shortage of donor kidney, people pay more and more attention. To explore the edge of donor kidney in the strict control of the screening criteria after the clinical application effect in living related kidney transplantation in the selection provide advantageous basis for clinical workers. 200 cases of recipients of organ transplantation center of Zhengzhou people's Hospital from January 1, 2012 to March 1, 2014 the implementation methods of living relative kidney transplantation surgery. According to the donor, divided into marginal donor group and standard donor group. The edge donor group for the study group, a total of 60 cases. The standard donor group as control group, 140 cases in the study group. 18 cases of donor age more than 60 years old; obese donor (BMI = 28kg/m2) and 10 cases of high; Blood donor in 10 cases; 8 cases of diabetic donor; renal artery stenosis in 10 cases, mild to moderate, lesions were located in the renal artery; for 2 cases of renal calculi, stone diameter were 2mm and 4mm; for kidney with cyst in 2 cases, cyst diameter were 10mm, 15mm. rules for clinical follow-up of 36m. Data of two groups were retrospectively analyzed. 1 weeks between the two groups after renal transplantation, 1,3,6,12,24,36 months estimated glomerular filtration rate (glomerular, filtration rate estimates, e GFR), postoperative liver function abnormalities, acute rejection, graft function recovery delay (delayed graft function, DGF), pulmonary infection the incidence of surgical complications, postoperative complications, and 1 years, 3 years of patient / graft survival rate. The results of each follow-up point receptor in the study group after e GFR average water is lower than the control group. After 1 weeks of E receptor GFR levels compared with the control group, the difference has statistics Statistically significant (t=1.762, P0.05). The study group of recipients after 1,3,6,12,24,36 months e GFR receptor levels compared with control group, the difference was not statistically significant (t=1.143, P0.05, t=1.281, P0.05, t=1.681, P0.05, t=1.262, P0.05, t=1.131, P0.05, t=1.331, P0.05); the study group and the control group receptor receptor after 1 years, 3 years survival rate were 98.3%/100%, 94.9%/98.6%, the difference between the two groups were not statistically significant (x 2=2.311, P0.05 x 2=2.234, P0.05). The study group and the control group receptor of recipients after renal transplantation for 1 years, 3 years survival rate were 98.3%/99.3%, 91.6%/96.4%, the difference between the two groups were no statistically significant (x 2=2.946, P0.05 x 2=2.017, P0.05); the study group and the control group of liver function damage receptor receptor after acute rejection, DGF, pulmonary infection, surgical complications, the difference between the two groups were not statistically significant (x 2=1.159, P0.05 x 2=1.685, P0.05, X 2=2.681, P0.05 x 2=1.184, P0.05 x 2=1.492, P0.05). Conclusion the clinical effect of early renal marginal donor receptor after surgery is ideal, but should be strictly controlled into standard. Influence of edge donor for the receptor to long-term graft function, still need to continue to observe. In the current tense situation for renal demand under the edge of donor kidney can be selectively as one of the effective ways to enlarge the source of living donor kidney.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R699.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王德;;醫(yī)界楷�！獏请A平[J];中國(guó)醫(yī)學(xué)人文;2016年11期

2 張海波;孟旭;韓杰;李巖;賈一新;曾文;許春雷;;腦死亡器官捐獻(xiàn)心臟移植供體保護(hù)性治療與功能評(píng)價(jià)[J];實(shí)用器官移植電子雜志;2016年05期

3 石炳毅;陳莉萍;;中國(guó)腎移植排斥反應(yīng)臨床診療指南(2016版)[J];器官移植;2016年05期

4 張雪山;王彪;宋秘;李珍;;體質(zhì)指數(shù)對(duì)移植腎功能恢復(fù)的影響[J];國(guó)際移植與血液凈化雜志;2016年02期

5 李靜;;淺析我國(guó)供體器官來(lái)源的現(xiàn)狀及其完善對(duì)策[J];醫(yī)學(xué)與法學(xué);2016年01期

6 邱濤;張璐;周江橋;陳忠寶;馬梟雄;張龍;;心臟死亡器官捐獻(xiàn)供腎移植與司法途徑標(biāo)準(zhǔn)供者供腎移植術(shù)后早期效果分析比較[J];中華移植雜志(電子版);2015年04期

7 薛武軍;;公民逝世后器官捐獻(xiàn)供腎評(píng)估方法及改善的研究進(jìn)展[J];器官移植;2015年03期

8 傅茜;王長(zhǎng)希;李軍;袁小鵬;鄧榮海;陳立中;費(fèi)繼光;邱江;鄧素雄;陳國(guó)棟;劉龍山;何曉順;;公民逝世后器官捐獻(xiàn)腎移植單中心233例臨床效果分析[J];中華泌尿外科雜志;2014年01期

9 齊太國(guó);孟慧林;金訊波;;中國(guó)腎臟移植的現(xiàn)狀分析[J];泌尿外科雜志(電子版);2013年03期

10 陳立中;陳國(guó)棟;;ABO血型不相容活體腎移植的熱點(diǎn)評(píng)析[J];器官移植;2013年04期

，

本文編號(hào)：1715130