肾移植受者肾动脉血管并发症10例的诊治体会

Clinical analysis on 10 patients with artery complications after renal transplantation

目的 探讨肾移植受者肾动脉血管并发症的类型、诊断与处理.方法 回顾性分析近5年472例肾移植中10例受者移植肾动脉血管并发症的诊治过程.结果 3例移植肾动脉破裂出血,其中1例为细菌感染,2例为霉菌感染,行移植肾切除和抗真菌、抗细菌治疗后恢复血液透析.4例移植肾假性动脉瘤形成,均为单支肾动脉,与髂外动脉端侧吻合,其中2例在术中发现,行髂外动脉修补,移植肾功能良好;2例为术后发现,二次手术行移植肾与髂内动脉再植和髂外动脉修补术,1例移植肾功能不全,1例移植肾功能良好.1例移植肾动脉血栓形成,确诊后二次手术切开肾动脉取出栓子,移植肾功能延迟恢复.2例移植肾动脉狭窄,采用介入球囊扩张成形术和覆膜支架置入术,患者肾功能恢复正常.结论 移植肾动脉血管并发症后果严重,不仅会影响到移植肾功能,更可能危及患者生命,早期诊断、紧急手术探查和特异性治疗,可取得比较满意的治疗效果.

Objective To investigate the diagnosis and treatment of artery complications after operation in renal transplantation.Method A retrospective study was performed on the experiences and lessons about 10 patients with artery complications postoperation in renal transplantation.Result Hemorrhage occurred in 3 cases because the rupture of kidney graft artery.Two cases of kidney graft artery were infected due to aspergilluses and 1 due to bacteria.The diagnoses were confirmed by pathological examination.Three cases were returned to hemodialysis after the removal of kidney grafts and administration of anti-fungal agents and antiseptics.Four patients of transplant renal pseudoaneurysm were all single branch.The end-to-side anastomosis was done between renal artery and the external iliac artery.Two cases were found in the operation,external iliac arteries were repaired and renal function was normal.Two cases were found postoperation.Kidneys were removed and second perfusion was done.The kidneys were replanted with renal graft artery anastomosed to the internal iliac artery.Delayed graft function （DGF） occurred in 1 case,and one case recovered with normal allograft function.In one patient with kidney artery thrombosis,the embolus was taken out by emergent reoperation,and renal function had delayed recovery.Two cases of transplanted renal artery stensis were treated by balloon angioplasty and metallic stent placement via femoral artery,and renal function was normal so far.Conclusion Artery complication is uncommon but serious after renal transplantation.It would not only affect renal function,but were more likely to endanger the patient＇s life.Early diagnosis,emergency surgical exploration and initiation of specific treatment in addition to graft nephrectomy would get satisfied results.