15例肾移植患者术后血管并发症的临床分析

目的 探讨肾移植术后血管并发症的诊断与处理.方法 回顾性分析15例肾移植患者术后血管并发症的诊治经验和教训.其中6例移植肾动脉吻合口出血,5例移植肾内动脉痉挛,3例移植肾动脉血栓形成,1例移植肾动脉狭窄.结果 6例移植肾动脉吻合口出血患者中3例为术后动脉吻合口出血,及时手术探查缝扎止血;另3例为感染性髂外动脉与肾动脉端-侧吻合口出血,其3例均切除移植肾,修剪受损血管壁,其中2例采用自体髂内动脉片修补于髂外动脉缺损处,1例修剪受感染的血管壁后,用游离切取相应长度的自体髂内动脉段串接于髂外动脉远、近端之间,治疗效果满意.5例患者移植肾内动脉痉挛,术中给予抗痉挛处理后移植肾由暗红、质地软转为饱满红润.3例移植肾动血栓形成,1例确诊后立即手术切开肾动脉取出栓子,2例采用溶栓治疗,其3例移植肾功能延迟恢复.1例移植肾动脉狭窄,采用球囊扩张成形术和内支架置放术,患者血压恢复正常,肾功能正常.结论 肾移植术后发生血管并发症,只要诊断准确、处理及时,可取得比较满意的治疗效果.

Clinical Analysis on Patients with Vascular Complications after Operation in Renal Transplantation

Objective To investigate the identification and management of vascular complications after operation in renal transplantation. Methods To make a retrospective study on the experiences and lessons about 15 patients with vascular complications postoperation in renal transplantation. Of which, 6 patients appeared hemorrhage of anastomosis site including 3 patients of mycotic hemorrhage, 5 patients of intrarenal artery spasm in renal allograft; and then 3 patients of kidney artery thrombosis and 1 patient of transplanted renal artery stensis. Results 3 of 6 patients with hemorrhage of anastomosis site were sutured up; transplanted renal allografts of 3 patients with mycotic hemorrhage were removed. 2 of 3 patients with external iliac artery appeared mycotic hemorrhage after kidney transplantation managed by the use of hypogastric artery autograft; 1 case with the diseased external iliac artery segnlent, about 2 cm in length, was reseeted and the gap was replaced by a 3 cm long hypogastrie artery autograft. The blood flow through the repaired external iliae artery and the blood supply to the lower extremity was adequate. 5 patients of renal allografts with ischemia just like a sign of hyperaeute rejeetion（HAR） were treatmented by anti-intrarenal artery spasm, ischemia gradually disappeared and renal functions recovered. In 1 patient of 3 patients with kidney artery thrombosis, the embolus was taken out by emergenfly reoperation, 2 patients were received successfully thrombolysis with interventional therapy, renal function of 3 patients delayed recovery. 1 case of transplanted renal artery stensis was treated by balloon angioplasty and metallic stent placement via femoralartery, blood pressure and renal function are normal so far. Conclusion The complications of vesse]s after operation in renal transplantation would get satisfied results if receiving accurate diagnosis and timely treatment.