糖尿病髂动脉硬化患者肾移植术51例报告

目的探讨糖尿病髂动脉硬化患者的肾移植手术特点。方法51例糖尿病合并髂动脉硬化的肾移植受者共行肾移植术54例次。其中肾动脉与髂外动脉直接端侧吻合13例次；切除硬化内膜，肾动脉与髂总／髂外动脉端侧吻合19例次；切除硬化内膜，肾动脉与髂内动脉钛环钉法端端吻合22例次。结果发生移植肾血流灌注不足致移植肾原发性无功能3例次，发生移植肾功能延迟恢复9例次（17．6％），其余42例次移植肾功能恢复良好。围手术期死亡2例（均为心跳骤停）。随访11—70个月，1年人／肾存活率为89．8％／87．8％，3年存活率为84．4％／81．3％。结论糖尿病髂动脉硬化患者移植肾动脉吻合困难，为保证移植肾有充足的血流灌注，应根据患者的不同情况选择吻合血管，并行硬化动脉内膜切除术。合并冠心病的患者肾移植术前应先行心肌再血管化手术。

Kidney transplantation in diabetic recipients with iliac atherosclerosis (report of 51 cases)

Objective To explore the techniques of renal transplantation in diabetic recipients with lilac atherosclerosis.Methods Overall,54 renal transplantations were performed in 51 diabetic recipients with lilac atherosclerosis.The renal arteries were end-side anastomosed to iliac arteries with atherectomy in 19 cases and without atherectomy in 13 cases,or end-end anastomosed to internal iliac arteries through titani- um stapler after atherectomy in 22 cases.Results Primary nonfunetion of renal allografts occurred in 3 cases due to poor blood perfusion of the renal grafts;delayed graft function occurred in 9 cases(17.6%), and the other 42 grafts functioned well immediately after transplantation.Two patients died of sudden cardiac arrest during the perioperative period.During a follow-up of 11-70 months,the 1-year and 3-year survival rates of recipients/grafts were 89.8%/87.8% and 84.4%/81.3% ,respectively.The main cause of graft loss was recipients' death with functioning graft.Conclusions The artery anastomosis of renal graft in di- abetic recipients with lilac atherosclerosis is difficult to perform.In order to achieve enough blood peffusion of the renal graft,it is important to select proper artery for anastomosis and to perform atherectomy.The recipi- ents with coronary artery disease should receive myocardial revascularization routinely before transplantation.