Zhang Shihao,Chen Yanfei,Zhu Yi,et al.Recent advances in the diagnosis and treatment of renal allograft compartment syndrome after renal transplantation[J].Journal of Clinical Pediatric Surgery,2025,(06):595-600.[doi:10.3760/cma.j.cn101785-202306026-017]
同种异体移植肾间隔室综合征诊疗进展
- Title:
- Recent advances in the diagnosis and treatment of renal allograft compartment syndrome after renal transplantation
- Keywords:
- Kidney Transplantation; Allografts; Renal Allograft Compartment Syndrome; Intra-Abdominal Hypertension; Reperfusion Injury
- 摘要:
- 移植肾间隔室综合征(renal allograft compartment syndrome,RACS)是被严重低估的同种异体肾移植术后并发症,严重者如未及时处理可导致移植肾丢失。RACS的临床症状和体征无特异性,且病因复杂多样。目前,RACS的病理生理学机制尚不完全明确,国内相关研究较少,国外也少有报道,以致在早期阶段常常难以引起临床医师重视,导致不可挽回的结局。目前相关临床研究主要集中在肾移植术中采取预防性无张力筋膜关闭以及术后常规超声监测。但由于RACS合并肾动脉狭窄和肾静脉狭窄的重叠表现,超声检查往往很难明确诊断,且人工补片植入后的风险尚存在争议。笔者认为未来对于 RACS 诊断的改进目标应集中在非侵入性的、可持续的精确检测方法上,对于高危患者应在移植术中行后腹腔筋膜减压。另外,当前植入物带来的风险远远小于RACS。本文阐述 RACS 的病因、病理学机制及诊疗策略,并为该病的预防与诊疗指出可能的方向。
- Abstract:
- Renal allograft compartment syndrome (RACS) is a greatly underestimated postoperative complication of allogeneic renal transplantation (RT).It may lead to a loss of transplanted kidney if not treated timely.Its clinical signs and symptoms of RACS are often non-specific and the causes of RACS diverse.Currently the pathophysiological mechanism of RACS has remained elusive.Few domestic and foreign reports are available.Clinicians tend to overlook it at an early stage and irreversible outcomes ensue.Most studies have focused upon prophylactic tension-free fascia closure during RT and postoperative ultrasonic monitoring.However,due to the overlapping manifestations of RACS plus renal artery stenosis and renal vein stenosis,ultrasonography is often difficult to make a definitive diagnosis and artificial patching remains controversial.Future improvements in the diagnosis of RACS lies in adopting non-invasive,accurate and sustainable methods of detection and posterior abdominal fascia decompression is mandatory for high-risk recipients.The current risk of implants is much lower than that of RACS.This review summarized the etiology,pathogenesis and diagnostics of RACS and proposed new approaches for its prevention.
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备注/Memo
收稿日期:2023-6-15。
基金项目:苏州市重点学科(szzdxk1901)
通讯作者:陈令秋,Email:qiuqiu20180885@sina.com