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。

Management of multiple allograft blood vessels in living related donor renal transplantation

Objective To investigate the methods of management and reconstruction for multiple allograft blood vessels in living related donor renal transplantation. Methods There were 45 cases with living donor renal artery variations and 7 cases with renal vein variations in this study, of those 3 cases both with artery and vein variations. The renal branch arteries were tied as they were associated with a blood-supply area smaller than 3 cm diameter when donor being operated. The renal branch veins were ligated when their diameters were 1/3 smaller than main stem veins of renal and no influence on blood circulation of kidney. The branch vessels were reconstructed ex vivo in 5 cases. The anastomosed arteries of recipients were selected according to their diameter, length, position of donor kidney branch arteries and condition of iliac artery and inferior epigastric artery of recipients. Results Good blood circulation of allogarfts were found in 48 cases after releasing the clamps of vessels, and their renal function were fluently recovered within one week of operation, and Doppler ultrasound examination showed that the transplanted kidney had good blood supply in one to two weeks postoperation. One case developed delayed graft function for aged donor. No severe complication occurred after follow-up 6 to 49 mouths, such as bleeding, renal artery embolism, urinary fistula, ureter necrosis and new onset hypertension. Conclusion Proper management for multiple vascular variations of living donor kidney transplantation will be well for graft function.