肾移植术中移植肾缺血的处理(附4例报告)

Reperfusion for the treatment of renal ischemia in renal transplantation(Report of 4 cases)

目的 :探讨肾移植术中移植肾缺血的原因、预防措施及再灌注处理方法。方法 :对移植术中移植肾缺血 4例 ,分别采用离断肾动、静脉 ,离体灌注或切开肾静脉 ,离断肾动脉 ,原位灌注和肾动脉再与髂内动脉吻合方法处理。结果 :4例患者术后移植肾功能恢复良好。随访 3～ 15个月 ,每天尿量 1 5 0 0～ 3 0 0 0ml,血肌酐均在正常范围 ,高血压均有不同程度缓解。结论 :移植术中移植肾缺血在排除超急排斥原因后 ,原因未明或不能迅速纠正 ,应果断重新吻合血管 ,行移植肾再灌注。为防止髂外动脉成角导致移植肾缺血 ,髂外动脉不宜游离过长 ,以 4cm左右为宜。

Objective:To study the causes, prophylactic measures of renal ischemia in renal transplantation and the treatment of reperfusion.Methods:artery and vein were severed in 3 cases, followed by perfusion in vivo; artery was severed while vein was opened in 1 case followed by perfusion in vivo; then, anastomose of renal artery and internal iliac artery was executed in 4 cases.Results:4 cases obtained normal renal function after operation.Conclusions:If renal ischemia is not attributable to hyperacute rejection, reperfusion should be undertaken, including perfusion in vitro and in vivo. External iliac artery should be separated about 4cm to prevent renal ischemia by means of its flexion.