介入诊疗技术在肾移植临床上的应用(附14例报告)

目的：探讨介入诊疗技术在肾移植临床上的应用。方法：回顾性分析14例肾移植术后患者接受介入诊疗的临床资料．其中肾移植术后肾功能丧失8例。移植肾动脉血栓形成2例．移植肾动脉狭窄2例。假性动脉瘤和术后并发重症高血压各1例。结果：对8例移植肾失功能者进行动脉造影。3例显示血管堵塞未予处置，另5例进行移植。肾动脉栓塞。其中3例栓塞术后完全停用免疫抑制剂．1例用小剂量激素维持．1例手术切除移植肾。1例重症高血压者经自体肾动脉栓塞．血压得到很好控制。接受肾动脉栓塞术患者均出现“栓塞后综合征”。2例移植肾动脉血栓形成患者溶栓成功．但。肾功能未恢复。2例移植肾动脉狭窄患者．1例放置支架失败。仅进行球囊扩张，术后血压控制良好。肾功能恢复。但6个月后血压再次升高、肾功能严重受损而行栓塞治疗，1例未处置。术后高血压得到控制。1例移植肾假性动脉瘤者经动脉造影证实后手术切除。结论：移植肾或自体肾动脉栓塞可替代手术切除移植肾和治疗肾移植术后重症高血压；移植肾动脉血栓形成可作溶栓治疗；移植肾动脉狭窄进行球囊扩张远期效果不佳。

Clinic application of interventional therapy in patients with kidney transplantation( Report of 14 cases)

Objective:To explore the results of clinic application of interventional therapy in patients with kidney transplantation.Method:Retrospectively analyzed the results of interventional therapy in treating 14 patients with kidney function failure (8 cases), transplanted kidney artery thrombosis (2 cases), transplanted kidney artery stenosis (2 cases), false aneurysm (1 case) and serious hypertension (1 case) after kidney transplantation.Result:All 8 cases of kidney failure, 3 cases showed kidney artery obstruction by arteriography and had no management, 5 cases were treated by artery embolism, three of which didn't need to take any immune inhibitor, only one case need a small dose of steroid, one need to cut off kidney by operation; 1 case of serious hypertension, after embolism of self-kidney artery, got better controlled; all patients had post-embolizing syndrome after operation of embolizing; 2 cases of kidney artery thrombosis had their thrombus dissolved successfully, but the kidney functions didn't get recovery; 2 cases with graft artery stenosis, one could control his blood pressure and got recovery of kidney function after enlarged the artery of stenosis though a balloon (put a stand into the artery of stenosis had failed), but a embolism had to perform after six month because of the recurrence of hypertension and serious kidney dysfunction; another patient's blood pressure was normal and didn't need management; 1 case who had false aneurysm confirmed by angiography and treated successfully by focal resection of the aneurysm.Conclusion:The method of embolizing the artery of transplanted kidney or auto kidney may replace the resection to cure serious hypertension after kidney transplantation; thrombolysis is efficient in treating kidney artery thrombosis; enlarging stenosis of graft artery by a balloon has a bad long-term therapeutic effect.