肾移植术后髂内动脉自体移植治疗感染性髂外动脉出血(附一例报告及文献复习)

Management of external iliac artery mycotic hemorrhage after kidney transplantation by the use of hypogastric artery autograft (report of one case and review of literature)

目的探讨肾移植术后感染性髂外动脉吻合口出血的处理。方法报告1例髂内动脉自体移植治疗感染性髂外动脉吻合口大出血病例,结合文献复习讨论。患者,男,25岁。肾移植术后第22、24、38天3次出现感染性移植肾动脉髂外动脉吻合口大出血,出血量分别达800、2500、3800ml。经输血、及时手术探查,两次吻合口缝合修补效果不佳,第3次手术切除移植肾,并将感染病变严重的髂外动脉段切除,髂外动脉缺损长约2cm,以3cm长的髂内动脉段移植修复。结果修复后髂外动脉血流通畅,患侧下肢血供良好,患者恢复血液透析,等待再次移植。结论感染性移植肾动脉髂外动脉吻合口出血为肾移植术后严重并发症,单纯修补常难以奏效,髂内动脉自体移植修补缺损合理可行,操作简易,效果较好。

Objective To investigate the management of external lilac artery mycotic hemorrhage after kidney transplantation. Methods A case of external lilac artery mycotic hemorrhage after kidney transplantation managed by the use of hypogastric artery autograft was reported with review of the literature. The massive blooding occurred 3 times after kidney transplantation in a male patient 25 years of age on the 22nd,24th and 38th day after transplantation. The blooding amounted to 800 ml,2500 ml and 3800 ml respectively. The blood loss was replaced and prompt surgical exploration was carried out with the blooding site at the anastomosis sutured up on the 1st and 2nd episode of bleeding. On the 3rd occurrence of bleeding, the diseased external lilac artery segment, about 2cm in length, was resected and the gap was replaced by a 3cm long hypogastric artery autograft. Results The blood flow through the repaired external lilac artery and the blood supply to the lower extremity was adequate, Periodic hemodialysis had been restored and the patient waited for reimplantation. Conclusions External lilac artery mycotic hemorrhage after kidney transplantation is a serious and fatal complication. Simple arterial repair is usually noneffective. Resection of the diseased mycotic segment of the external lilac artery, with repairing of the gap with a hypogastric artery autograft is rational, feasible and simple. The procedure is highly recommended.