肾移植术后血管并发症的临床分析(附24例报告)

Clinical Analysis of Vascular Complications After Renal Transplantation(Report of 24 Cases)

目的总结肾移植术后血管并发症的诊治经验。方法选取2012年1月至2021年3月昆明市第一人民医院泌尿外科肾移植术患者610例,其中24例发生血管相关并发症,发生率为4.3%,回顾性分析此24例患者的临床资料及诊治经过。结果24例患者中,移植肾动脉吻合口出血5例,其中3例移植肾动脉吻合口出血患者及时行手术探查止血,1例切除移植肾,1例死亡;移植肾内动脉痉挛5例,均于术中开放血流后即行抗痉挛治疗后,移植肾由暗红、质软转为红润饱满;移植肾动脉狭窄13例,均行介入球囊扩张成形术,其中3例行支架植入术,均恢复良好,1例移植肾动脉血栓患者行介入治疗,取栓成功;移植肾静脉血栓患者1例,行移植肾切除。结论肾移植术后发生血管并发症进展迅速,如不及时处理后果严重,而诊断准确,及时处理,则可取得比较满意的治疗效果。

Objective To summarize the experience of diagnosis and treatment of vascular complications after renal transplantation.Methods From January 2012 to March 2021,610 cases of renal transplantation in the Department of Urology,Kunming First People’s Hospital were selected.Among them,24 cases had vascular related complications,the incidence rate was 4.3%.The clinical data,diagnosis and treatment of 24 cases were retrospectively analyzed.Results Among the 24 patients,5 patients suffered from anastomotic bleeding of renal artery grafts.Among them,3 patients suffered from anastomotic bleeding of renal artery grafts underwent timely surgical exploration to stop bleeding,1 patient underwent nephrectomy and 1 patient died;5 cases of intra renal artery spasm were treated with antispasmodic therapy.The grafts were changed from dark red and soft to full red;Thirteen patients with renal artery stenosis underwent balloon angioplasty.Three of them underwent stent implantation,and all recovered well.One patient with renal artery thrombosis underwent interventional therapy,and thrombectomy was successful;One patient with vein thrombosis underwent nephrectomy.Conclusion Vascular complications after renal transplantation progress rapidly,if not treated in time,the consequences are serious,and accurate diagnosis,timely treatment,can achieve a satisfactory therapeutic effect.