男性肾移植受者手术前后的勃起功能状况及动脉吻合方式对其影响

Erectile Function in Male Kidney Transplant Recipients and Effects of Different Methods of Renal Arterial Anastomosis

目的:评价男性肾移植受者手术前后的勃起功能状况及不同动脉吻合方式对勃起功能的影响。方法:选取22～60岁、移植后存活1年以上、血清肌酐9个月内维持在200μmol/L以下的已婚男性肾移植受者55例,其中采用供肾动脉与髂内动脉端端吻合的39例,供肾动脉与髂外动脉端侧吻合的16例。运用IIEF-5对患者移植前及移植后3、6、9个月的勃起功能进行调查,并评价移植所采用的动脉吻合方式对其影响。其中25例分别在移植前和移植后1个月检测其垂体性激素的变化。结果:肾移植术后3、6、9个月患者的IIEF-5评分与术前比较,差异有显著性(P<0.05);IIEF-5评分肾移植术后6个月、9个月患者与术后3个月比较,差异有显著性(P<0.05);术前血液透析时间在12个月以内的患者IIEF-5评分高于血液透析时间在12个月以上的患者(P<0.05);移植后9个月髂外动脉端侧吻合者的勃起功能好于髂内动脉端端吻合者,差异具有显著性(P<0.05);移植术后1个月患者的垂体激素水平与移植前差异有显著性(P<0.05)。结论:肾移植后,患者的勃起功能及垂体激素水平得到了改善,而采用髂外动脉与供肾动脉吻合的患者勃起功能恢复要好于采用髂内动脉与供肾动脉吻合的患者。

Objective： To evaluate erectile function in men with renal failure before and after kidney transplantation and the effects of different methods of renal arterial anastomosis. Methods： Fifty-five married males, aged 22-50 years, who had received kidney transplantation at least one year before and whose serum creatinine was under 200 μmol/L , were selected in the study. The end-to-end revascularization to the internal iliac artery was accomplished in 39 of them, and the end-to-side revascularization to the external iliac artery was conducted in 16. Their erectile function was investigated according to the International Index of Erectile Function-5 （ⅡEF-5） before kidney transplantation and 3, 6 and 9 months after it. The effects of different methods of renal arterial anastomosis were evaluated and hypophyseal hormones determined in 25 of them. Results： ⅡEF-5 was higher in the patients 3, 6 and 9 months after trans-plantation than before it （ P 〈 0.05 ） and 6 and 9 months after transplantation than 3 months after it （ P 〈 0.05 ）, so was it in the patients with less than 12 months hemodialysis than those with over 12 months（P 〈 0.05 ） and in the patients with end-to-side revascularization to the external iliac artery than those with end-to-end revasculatization to the internal iliac artery （ P 〈 0.05 ）. The differences between the level of hypophyseal hormones and that of sex hormones before transplantation were significant （P 〈 0.05 ）. Conclusion ： Erectile function and the level of hypophyseal hormones were improved after kidney transplantation, and the patients who received end- to-side revascularization to the external iliac artery experienced better erectile function recovery than those who underwent end-to-end revascularization to the internal iliac artery.