肝移植术后肝动脉狭窄的内支架治疗

目的 对内支架植入术治疗肝移植术后肝动脉狭窄的价值进行初步的探讨。方法 对34例肝移植发生肝动脉狭窄、闭塞患者行球囊扩张治疗，其中5例患者接受内支架植入治疗，3例为球囊扩张治疗无效患者，1例为球囊扩张后出现肝动脉内膜撕裂，另1例为肝动脉狭窄伴吻合口破裂出血。结果 5例患者均成功进行了内支架植入治疗，其中1例肝动脉狭窄伴吻合口破裂出血的患者植入支架后24h内发生支架内急性血栓形成，经手术行肝动脉重建治疗，其余4例术后治疗效果良好。结论 介入方法治疗肝移植术后肝动脉狭窄具有微创、安全、有效的优势，对于球囊扩张治疗无效或合并吻合口破裂出血的病例，可采用内支架植入治疗。     

Balloon angioplasty for pulmonary artery stenosis after lung transplantation

We report here a successful case of balloon angioplasty for a stenosis of the pulmonary artery after lung transplantation. A 49-year-old patient with end stage diffuse bronchiectasis with sinusitis underwent bilateral living donor lobar lung transplantation. After treatment of postoperative right pneumothorax, a perfusion lung scan revealed deficient perfusion in the left lung. Pulmonary angiography showed a severe stenosis in the left pulmonary artery just distal to the anastomosis. Percutaneous balloon angioplasty improved both pulmonary perfusion and respiratory function.     

Renal artery stenosis after renal transplantation

Stenosis of the transplant renal artery was discovered in 113 of 971 (11.6%) renal transplantation patients between three months and five years after transplantation. Diagnosis was reached by angiography performed because of hypertension, with or without impaired renal function. The stenosis was repaired in 63 patients with cure or improvement of hypertension in 35, and improvement of renal function in 12 of 23 patients with impaired renal function. The different types of stenosis were: recipient renal artery stenosis, suture line stenosis, donor artery stenosis (the most common), and multiple stenoses. The causes implicated were: recipient atheroma, faulty suture technique, hemodynamic disorders, trauma, and immunologic mechanisms. As the incidence of this complication is underestimated, routine angiography in all transplant recipients is suggested.     

Renal artery stenosis after renal transplantation

Renal artery stenosis occurred in eight of fifty patients who received a renal transplant during a three year period. The evaluation and management of these cases is summarized. Trauma associated with kidney procurement, preservation, or arterial anastomosis as well as the rejection process itself may ontribute to the development of these lesions. Arteriography may be indicated at an earlier stage in patients who respond poorly to medical treatment of repeated episodes of “rejection”.     

Reversible renal artery stenosis in renal transplantation.

Spontaneous regression of an arterial stenosis in a renal transplant recipient is documented. Implications of this observation and possible pathogenic mechanisms are discussed.     

同种异体肾移植术后移植肾动脉狭窄 介入治疗的临床疗效分析

目的探讨同种异体肾移植术后移植肾动脉狭窄（TRAS）介入治疗的临床疗效。方法介入治疗同种异体肾移植术后TRAS患者22例,其中单纯球囊扩张治疗10例（球囊组）,内支架治疗12例（支架组）。对所有患者术前及术后2年内血压、肾功能以及生活质量进行评估,并与同期接受单纯药物治疗的6例TRAS患者（药物组）进行比较。结果球囊组技术成功率90.00%,支架组技术成功率100%。术后在血压及肾功能改善方面,球囊组和支架组均取得显著疗效,两组近期疗效未见明显差异,药物组疗效不满意。术后随访6个月～2年,支架组再狭窄率16.67%,除1例不明原因治疗无效外,其余11例均能比较健康的生活和工作。球囊组手术失败1例,再狭窄率达40.00%。结论内支架植入术可作为TRAS特别是I型及Ⅱ型狭窄的首选治疗方法。     

Value of arterioscopy in the prevention of renal artery stenosis after transplantation

Renal artery stenosis is frequent after transplantation. The systematic pre-operative search for arterial injuries by angioscopy allows a reduction in their incidence. The authors report a series of 60 transplantations with pre-operative angioscopy, which revealed benign injuries and two major injuries which were successfully treated surgically. This prevention allows a reduction in the incidence of stenosis from 12 to 6.6% according to a previous series of 210 transplantations without angioscopy.     

Treatment of renal artery stenosis following kidney transplantation

Stenoses of the renal artery occurred in 4.6% of 415 transplanted kidneys between 1969 and 1983. Most of them were caused by traumatic intima-lesions and were localised postanastomotically. The best therapeutic procedure seems to be the transperitoneal approach with widening venous patch plasty or venous bypass. The percutaneous transluminal catheter dilatation may be successful in suitable cases.