尿毒症合并DebakeyⅡ型主动脉夹层手术治疗并肾移植术个案分析

Case analysis on a patient suffering with uremia complicated with Debakey typeⅡaortic dissection and receiving surgical treatment and kidney transplant

目的探讨尿毒症患者合并主动脉夹层(AD)的原因及手术治疗后并行肾移植临床治疗情况。方法通过1例病例资料分析了尿毒症合并DebakeyⅡ型主动脉夹层的手术治疗并肾移植术情况进行分析。结果本例尿毒症合并DebakeyⅡ型AD患者行手术治疗并肾移植术,术后恢复良好,并继续规律行血液透析治疗,随访期间病情均稳定,血尿常规、肝肾功能均恢复正常。结论尿毒症合并AD时,其临床症状、体征可不典型,易误漏诊,临床医生尤其要重视,可行超声及胸腹主动脉血管造影检查鉴别;其行肾移植术,围手术期心脑血管风险大,血管吻合技术要求高,增加肾移植手术的风险和难度。

Objective To investigate the causes of uremic patients with aortic dissection(AD)and the clinical treatment of renal transplantation after surgical treatment.Methods The conditions of surgical treatment and kidney transplant for a patient with uremia complicated with DebakeyⅡaortic dissection were analyzed through the analysis on the case data.Results This case of uremia complicated with Debakey typeⅡaortic dissection underwent surgery and renal transplantation.The postoperative recovery was good,and the hemodialysis treatment was continued regularly.During the follow-up period,the condition was stable,and the routine blood and urine,liver and kidney functions returned to normal.Conclusions When uremia complicated with AD,its clinical symptoms and signs can be atypical and easy to be misdiagnosed.Clinicians should pay special attention to it,which could be differentiated by ultrasound and thoracoabdominal aortic angiography.The perioperative cardiovascular and cerebrovascular risk is high,and the technical requirements of vascular anastomosis are high,which increases the risk and difficulty of renal transplantation.