探讨肾动脉多支畸形的供肾在体外血管重建中的方式及在肾移植中的应用

目的探讨。肾动脉多支畸形的供。肾在体外血管重建中的方式及其在肾移植中的应用。方法对5例肾动脉多支畸形供肾的修整采取截取受者同侧髂内动脉的方法，依据供肾动脉的分支数而保留髂内动脉的分支数；在体外将供肾动脉各分支与髂内动脉大分支的开口进行端端吻合，然后将髂内动脉主干与受者髂外动脉行端侧吻合。将肾动脉重建后的供肾应用于双侧肾动脉瘤患者的自体肾移植术1例、亲属活体供肾肾移植术3例和尸体肾移植术1例。结果术后5例受者均未发生外科并发症。1例术后发生短暂的急性。肾小管坏死，但48h后进人多尿期，肾功能恢复顺利。术后随访10-36个月，受者移植。肾功能全部正常，肾动脉及分支未发生血栓或闭塞。结论采用受者的髂内动脉体外重建供。肾动脉的方法，可有效修复肾动脉3支以上以及。肾动脉过短的供肾，是一种安全可行的血管重建的方法，血管并发症较低，可有效应用于肾移植。     

肠道血管畸形34例诊治体会

目的 总结肠道血管畸形的诊治经验。方法 对３４例肠道血管畸形的原因,诊治进行回顾性分析。结果 （１）本组下消化道出血以反复性,间歇性血便或潜血阳性为主。（２）病变位于小肠者多见（２５例,占７３．５％）。（３）病理以２￣３年者最多（１７例,占５０％）。结论（１）肠道血管畸形已成为下消化道出血的主要原因,值得重视。（２）选择性肠系膜血管造影是诊断本病的最好方法。（３）外科手术是治疗肠道血管畸形出血的最     

手臂部血管畸形的手术治疗

目的 探讨手臂部血管畸形的手术治疗效果。方法 回顾41例手臂部血管畸形的临床表现及诊断依据，采用瘤体切除手术的方法，术后进行疗效观察，分析诊断依据及复发病例。结果 随访6个月—5年6个月，3例复发，2例术区麻木，1例切口边缘皮肤部分坏死。结论 手术治疗手臂血管畸形的效果肯定，复发率低。     

血管瘤和血管畸形41例

血管瘤和血管畸形是血管外科常见的先天性血管病变,病情复杂多样,治疗难度大,且术后容易复发。2006年3月—2009年5月,我院共收治血管瘤和血管畸形患者41例,报道如下。     

移植肾血管慢性排斥的机理研究

肾移植术的近期疗效已取得显著效果，但其远期效果仍不理想。近年来的研究结果表明肾血管的慢性排斥是其重要原因，移植肾血管阻塞是导致移植肾慢性失功，移植肾丧失的主要障碍。本文将对这方面的研究结果及其进展予以简要综述。     

血管灌注技术在周围动静脉畸形血管形态学研究中的应用

目的探索利用离体血管灌注技术对周围动静脉畸形（Arteriovenous malformation,AVM）进行三维血管形态学研究的可行性。方法切取5例扩张期患者的AVM病灶,利用离体血管灌注技术显示其三维血管形态,并测量主要血管口径。结果使用血管灌注的方法 ,可以较方便地测量AVM中的血管口径,能客观显示AVM的形态,并清晰地展示AVM血管之间复杂的交通情况。结论血管灌注是一种研究AVM异常血管形态学的理想方法 。     

超声多普勒在体表血管畸形诊治中的应用

探讨超声多普勒在体表血管畸形诊治中的作用。采用多普勒血流仪ＤＵＦ（Ｄｏｐｐｌｅｒｕｌｔｒａｓｏｎｉｃｆｌｏｗｍｅｔｅｒ）并结合彩色多普勒血流成像ＣＤＦＩ（Ｃｏｌｏｒｄｏｐｐｌｅｒｆｌｏｗｉｍａｇｉｎｇ）、血管造影ＳＡ（Ｓｅｌｅｃｔｉｖｅａｎｇｉｏｇｒａｐｈ）、术后组织学检查作自身对照２８例、３７个瘤体及ＤＵＦ术中应用１２例。ＤＵＦ对体表部位的高或低流量性病损的定性诊断与上述三种检查基本相符,其还能指导选择性结扎瘤体内的血管及术中避免损伤体表知名动脉,但不能提示病损结构和范围;ＣＤＦＩ除能提供病损区动、静脉血流信号外,尚可提示深部（肌层）病损情况,但不能显示病损的完整结构;ＳＡ既能提示病损的血流情况,也能显示病损大小和范围。总之,ＤＵＦ结合临床可初步明确体表血管畸形的高或低流量性病损,该方面诊断ＣＤＦＩ更为精确,ＣＤＦＩ与ＳＡ结合对血管异常的诊断和治疗是必要的。     

标记定位在肠血管畸形外科治疗中的应用

目的探讨肠血管畸形的术中定位方法。方法对15例肠血管畸形患者,经选择性肠系膜血管造影证实具体出血动脉后,再进一步对出血分支动脉行超选择性插管,置入导引钢丝或造影导管作为术中定位标记。结果本组肠血管畸形位于空肠6例、回肠5例、空肠加结肠1例、结肠3例。手术时均顺利找到标记物并切除病变肠管,从而获得满意疗效。结论经选择性肠系膜血管造影明确畸形的肠血管后,置入标记物作为术中寻找病变部位的定位标记,是一种非常有效的方法。     

Aortoiliac surgery concomitant with kidney transplantation: a single center experience

Abstract: Introduction: Aortoiliac pathology in kidney allograft recipients is not rare but treatment timing is controversial. As most publications on this topic are case reports it’s difficult to evaluate long‐term outcomes of those clinical challenges. Herein we report long‐term results of these procedures. Methods: From 1970 to 2006, 1544 kidney transplants were performed in our center. Thirty patients underwent aortoiliac surgery simultaneously with kidney transplantation. We analyzed their clinical records to come up with outcomes of these complex clinical challenges. Results: Vascular pathology was distributed as following: 19 stenoses treated with endarterectomy (15), aortoiliac bypass (two), aorto‐bi‐iliac bypass (one) and aorto‐bifemoral bypass (one); and 11 aneurysms treated with arterioplasty (four), aorto‐bi‐iliac bypass (four) and iliac‐iliac bypass (three). In 24 cases (80%) the necessity of vascular surgery was established intraoperatively as vessels’ conditions did not permit safe anastomoses and jeopardized graft survival. Mean follow‐up was 59 months (12–125). Five (16.7%) grafts were lost and three (10%) patients died in the first post‐operative month: acute myocardial infarction (two) and non‐viable kidney (one). Three patients died six, seven and 10 yr after the procedure. Nineteen patients are currently well with functioning grafts. Conclusions: Surgical correction of aortoiliac pathology may be performed simultaneously with kidney transplantation with acceptable outcome. This complex surgery can be performed in centers with experienced vascular surgeons. Specific vascular imaging should be performed regularly on patient at risk of aortoiliac disease before insertion and while on waiting list.     

Renal vessel reconstruction in kidney transplantation using a polytetrafluoroethylene (PTFE) vascular graft.

BACKGROUND: We report a rare experience in reconstructing short renal vessels in kidney transplantation using polytetrafluroethylene (PTFE) vascular grafts. METHODS: The short renal vessels in three kidney grafts were managed by the interposition of PTFE vascular grafts. Two grafts were from deceased donors and the third was a renal auto-transplant graft. RESULTS: PTFE grafts were used to lengthen short renal veins in two kidney grafts and a short renal artery in one. The warm ischaemia time was under 1 h and all kidneys functioned well post-operatively. Excellent blood perfusion in the three renal grafts was present on postoperative MAG 3 renal scan. No intra-operative or post-operative complications were encountered. CONCLUSIONS: In the three described patients, the use of PTFE vascular graft presented no additional morbidity to the kidney transplant operation and no post-oerative complication was related to its use. However, more data are necessary to conclude that PTFE graft can be used safely in kidney transplantation.     

Ex vivo ureteroscopic treatment of calculi in donor kidneys at renal transplantation

PURPOSE: We evaluated the safety and efficacy of ex vivo ureteroscopy (ExURS) as a means of rendering the donated kidney stone-free at live donor renal transplantation. MATERIALS AND METHODS: A total of 10 suitable kidney donors with small, unilateral nonobstructive calculi underwent live donor nephrectomy (8 open flank, 2 hand assisted transperitoneal). Immediately after cold perfusion, ExURS was performed in an iced saline solution. Access to the collecting system was via the ureteral stump. Calculi were either removed with endoscopic baskets and/or completely fragmented with Holmium laser lithotripsy. RESULTS: Access to the renal collecting system was technically successful in all cases. A total of 10 stones, ranging in largest diameter from 1 to 8 mm (average 5.2) were visualized. Of the kidneys 6 had solitary stones, 2 had 2 stones and 1 had no stone. Of 10 stones 9 were successfully removed and/or fragmented with an average procedure time of 6.5 minutes (range 3 to 28). Indwelling ureteral stents were placed at transplantation in 5 of 10 kidneys. There were no intra-operative or postoperative ureteral complications. At 1 month after transplant serum creatinine ranged from 0.9 to 2.7 mg/dl (average 1.5). At a mean followup of 33.2 months new stones have not formed in any recipients and at mean 36.4-month followup no new calculi have formed in the remaining kidney of any donors. CONCLUSIONS: ExURS is a technically feasible means of rendering a stone bearing kidney stone-free without compromising ureteral integrity or renal allograft function.     

Ex vivo reconstruction of the donor renal artery in renal transplantation: a case–control study

Transplantation of renal allografts with anatomic variability or injured vasculature poses a challenge to the transplanting surgeon but can be salvaged for transplantation with ex vivo bench reconstruction of the vasculature. We investigated whether renal allograft function is impaired in these reconstructed allografts; compared to the donor‐matched, un‐reconstructed allograft. Reconstructed allografts were transplanted into 60 patients at our institution between 1986 and 2012. A control group was selected from the matched pair of the recipient in deceased donor transplantation. We found no significant difference in the overall graft and patient survival rates (P = 1.0, P = 0.178). Serum creatinine levels were not significantly higher in the study group at 1, 3 and 12 months postoperatively. There were two cases of vascular thrombosis in the study group that were not related to the ex vivo reconstruction. A significantly greater proportion of reconstructed patients were investigated with a colour duplex ultrasound postoperatively (0.007). Although we have demonstrated a higher index of suspicion of transplant failure in patients with a reconstructed allograft, this practice has proven to be a safe and useful technique with equivocal outcome when compared to normal grafts; increasing the organ pool available for transplantation.     

肾移植中供肾血管变异的处理

目的提高血管变异的供肾的临床应用价值。方法根据具体情况，将血管变异的供肾进行合并、修整、重建等，使供肾安全、有效的移植给受者。结果78只供肾动脉变异(包括23只供肾静脉变异)经处理后，77只供肾良好。供肾移植后数分钟内有尿排出，2周内肾功能恢复正常，1年后随访无并发症。仅有1例因肾静脉回流障碍，被迫切除移植肾。结论供肾血管变异只要正确处理，移植后可获得良好效果。     

活体肾移植供肾多支血管处理的体会

目的探讨活体肾移植供肾多支血管的处理及重建方法。方法 49例供体,供肾有多支动脉变异45例,有多支静脉变异7例,其中3例为肾动脉、静脉同时多支血管变异。供肾切取术中,对于供血面积直径小于3cm且影响操作的分支动脉,术中即予结扎、离断;多支静脉,如直径为主干的1/3以下且试夹闭该静脉未发现明显淤血等血液回流障碍者,给予结扎、离断。5例采用体外血管重建。受体肾移植术中根据分支动脉管径、长度及位置及受者髂动脉和腹壁下动脉的情况等综合条件来选择受者相应的动脉吻合。结果 48例动脉分支吻合者在开放血流后搏动良好、吻合口通畅,术后1～7d内肾功能恢复正常、术后1～2周彩色多普勒超声检查,提示该分支动脉供血区域丰富。肾静脉分支结扎者未发现淤血现象。1例高龄供肾者发生肾功能延迟恢复。术后无出血、肾动脉栓塞、尿瘘、输尿管坏死和新发高血压等并发症。结论正确处理移植肾多支血管变异,可获得良好移植效果。     

Minimally invasive video-assisted kidney transplantation (MIVAKT)

BACKGROUND: Minimally invasive surgery has been applied to nearly all fields of surgery due to its advantages such as reduced morbidity, a better cosmetic outcome, and early recovery. The recent advances in its technique have allowed us to use modified minimally invasive surgery technique in the field of kidney transplantation. MATERIALS AND METHODS: From January 2004 to March 2006, minimally invasive video-assisted kidney transplantation was carried out in 20 patients. Many clinical variables were compared with the conventional method. The operative procedure began with a 7 to 8 cm skin incision. A laparoscopic balloon dissector was used to create the retroperitoneal space for the placement of the grafted kidney. Vascular anastomosis and ureteroneocystostomy were performed under direct vision and with video-assisted TV monitoring. RESULTS: The average length of the wound was 7.8 cm and it was placed below the belt line. The average operating time was 186 min. Less analgesic was given compared with conventional methods. There was one postoperative complication, a mild lymphocele. All patients showed normalized serum creatinine levels within 4 d. All grafted kidneys showed normal findings on the postoperative ultrasound and renal scans. CONCLUSIONS: Minimally invasive video-assisted kidney transplantation is technically feasible and may offer benefits in terms of better cosmetic outcomes, less pain, and quicker recuperation than conventional kidney transplantation.     

多囊肾患者保留原肾的肾移植疗效分析

目的探讨多囊肾患者保留原肾的肾移植特点、手术方式及疗效。方法回顾性分析25例多囊肾患者肾移植前后原双侧肾脏体积变化以及移植肾功能恢复情况,以25例原发病为慢性肾小球肾炎肾移植患者为对照组。结果25例患者1年人/肾存活率分别为96.0%/92.0%,3年人/肾存活率为90.0%/90.0%;发生急性排斥反应7例(28.0%),移植肾失功2例(8.0%),死亡1例(4.0%);23例患者原肾脏逐渐缩小,左肾长、宽、厚由术前(20.72±4.40)cm、(14.11±2.45)cm、(9.01±1.05)cm缩小至(14.70±2.00)cm、(10.30±1.49)cm、(6.87±0.94)cm,右肾长、宽、厚由术前(20.11±2.64)cm、(15.10±2.14)cm、(9.18±0.96)cm缩小至(15.00±1.84)cm、(10.45±1.28)cm、(6.80±1.15)cm(P<0.05);23例患者移植肾功能稳定,血尿逐渐消失,术前血压(134.20±3.12)/(95.23±2.49)mm Hg(1 mm Hg=0.133 kPa),术后(128.58±2.59)/(92.34±3.40)mm Hg(P>0.05)。对照组1年人/肾存活率分别为100.0%/100.0%,3年人/肾存活率为96.0%/96.0%;发生急性排斥反应6例(24.0%),移植肾失功1例(4.0%),死亡1例(4.0%),与多囊肾组比较均P>0.05,差异无统计学意义。结论多囊肾患者肾移植,不切除原病变肾脏移植效果满意,移植后应严密观察患者移植肾功能、血尿和感染情况。     

Vascular reconstruction in monolateral dual kidney transplantation with multiple arteries

We report the results of monolateral dual kidney transplantation with grafts with multiple arteries. Among the 42 monolateral DKT performed in a seven-yr period, 12 (28.5%) patients received renal grafts with multiple arteries. In six patients, the accessory arteries were anastomosed end-to-side or side-to-side on the aortic patch. In six patients, with three or more accessory arteries, a vascular reconstruction with an inferior vena cava patch was performed, before implanting the kidney. There were no intraoperative complications in the entire series, and there were no immediate vascular complications. Vascular reconstruction of kidneys with multiple arteries may be performed safely even in monolateral dual kidney transplantation. Inferior vena cava may be an attractive alternative in vascular reconstruction for kidneys with multiple arteries.