移植肾动脉狭窄10例

Transplant renal artery stenosis in 10 cases

背景:移植肾动脉狭窄的外科治疗包括摘取栓塞或切除狭窄段后重新吻合血管,或者利用自身静脉进行肾动脉与髂动脉的搭桥手术,虽然手术技术逐渐改进,但仍有部分病例发生移植肾的丧失。目的:分析移植肾动脉狭窄的病因、分类、诊治方案的选择及效果。方法:对2002/2010收治的10例移植肾动脉狭窄患者临床资料进行回顾性分析。其中男8例,女2例;年龄36.9(22～55)岁。发病时间移植后5d～7年半,其中8例患者为移植后半年内发病。常规超声筛查,数字减影血管造影检查确诊。结果与结论:除1例患者拒绝数字减影血管造影检查以及1例开放手术患者,最终有8例接受介入治疗,8例数字减影血管造影检测均确诊移植肾动脉狭窄,狭窄程度为60.3%(40%～80%)。4例经皮腔内血管成形,4例支架置入,其中7例均取得显著的效果,5例肌酐降至正常,2例肌酐降至发病前水平,所有患者移植后早期即尿量显著增加、血压降至正常。在之后的长期随访中,也未发现再次狭窄或者血栓形成等并发症。但其中1例经皮腔内血管成形术中出现动脉出血,最终导致移植肾切除。提示对于移植肾动脉狭窄患者,应结合发病时间、发病原因以及狭窄程度等因素综合分析,选择合适的治疗方案,以取得最佳的疗效,并将风险降到最小。

BACKGROUND：The embolization removal,anastomosing the vessels after resecting stenotic segment,or bridging the renal artery and iliac artery with self-vein,are used for the treatment of transplant renal artery stenosis （TRAS）. Though the surgery skill is improving,some cases still suffered failure of renal functions. OBJECTIVE：To investigate the causes,categorization,diagnosis,therapy and the curative effect of TRAS. METHODS：The clinical data of 10 post renal transplant patients who got their final diagnosis of TRAS between 2002 and 2010 was retrospectively analyzed,including 8 males and 2 females,aged from 22 to 55 years,with a mean age of 36.9 years. The on set time of TRAS was from 5 days to 7.5 years after renal transplantation,while 8 occurred in 6 months after renal transplantation. The color Doppler ultrasonography was applied for screening. The digital subtraction arteriography was applied for diagnosis. RESULTS AND CONCLUSION：Except for 2 patients （one rejected DSA,another underwent open operation）,all the other 8 patients eventually underwent interventional therapy,and got their stenosis confirmed by arteriography. The degree of stenosis was 40%-80%,with a mean degree of 60.3%. Four patients underwent percutaneous transluminal angioplasty （PTA）,the other 4 underwent percutaneous transluminal angioplasty and stent placement （PTAS）. The curative effect of these 7 patients was perfect. 5 patients＇ serum creatinine levels returned to normal,2 patients＇ dropped to the level before stenosis. Early after the interventional treatment,all the 7 patients got urinary volume increasing and a well control of the blood pressure. During the follow-up periods,none of those patients showed any signal of restenosis or thrombosis of the transplanted renal artery. One patient failed with the operation of PTA,and the transplanted kidney was removed. The results revealed that,for the patient with TRAS,the onset time,etiological factors and the degree of stenosis,should all be analyzed. We should make up a proper treatment program,in order to gain the best curative effect,and make the risk minimized meanwhile.