糖尿病性肾病合并髂动脉严重硬化患者的肾移植手术处理

目的 探讨糖尿病肾病合并髂动脉严重硬化患的肾移植手术技巧。方法 15例糖尿病肾病合并髂动脉严重硬化的肾移植患，8例次清除髂内动脉内膜硬化斑块后，由钛轮钉端端吻合动脉；10例次剥离髂总或髂外动脉硬化内膜，与肾动脉端侧吻合。结果 术后心跳骤停死亡1例；1例病人连续3次发生移植肾血流灌注不足导致的移植肾原发性无功能，第4次肾移植肾功能良好；其余13例病人首次移植术后肾功能良好。结论 严重动脉硬化患的动脉吻合困难，为保证移植肾有足够的血流灌注，应根据病人的不同情况选择吻合血管，并行硬化内膜切除术。

The Techniques of Renal Transplantation in Diabetic Nephropathy Recipients with Severe Iliac Atherosclerosis

Objective To study the techniques of renal transplantation in recipients with severe atherosclerosis. Methods There were 15 recipients with severe iliac atherosclerosis. In 8 cases the renal artery was end-end anastomosed to the internal iliac artery by titanium stapler after atherectomy, and in 10 cases the renal artery was end-side anastomosed to the external or common iliac artery after atherectomy. Results One patient died of cardiac arrest, one patient lost the grafts for three consecutive times due to poor perfusion of the kidney and got a successful transplantation in the fourth time. The grafts of other 13 patients functioned well. Conclusion It is difficult to perform kidney transplantation for these recipients with severe atherosclerosis. In order to achieve enough blood perfusion of the graft, it is important to select proper artery for anastomosis and perform atherectomy before anastomosis.