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目的探讨肾移植术中急性移植肾缺血的诊断和治疗。方法总结27例肾移植术中急性移植肾缺血患者的临床资料。结果27例肾移植术中肾缺血事件病因:血管痉挛11例,其中肾外动脉痉挛5例,肾内血管痉挛6例;肾血流灌注不足6例,肾动脉狭窄1例,肾动脉血栓2例,肾静脉血栓1例,肾动/静脉扭转3例;肾动脉内膜损伤2例,超急性排斥反应1例。2例肾动/静脉血栓溶栓治疗成功。4例(肾动脉狭窄1例、肾动脉血栓1例、肾动脉内膜损伤2例)术中切取移植肾二次灌注再吻合成功。1例超急性排斥反应,切除术后病理证实。其余病例经抗凝、解痉、升压、调整移植肾位置等治疗缓解。1例术后因急性排斥并移植肾破裂手术切除。余25例中22例人肾存活良好,3例移植肾因慢性移植物肾病而失功。8例发生肾小管坏死。急性排斥4例,用甲泼尼龙或抗胸腺细胞球蛋白(ATG)治疗后3例逆转。结论肾移植术中发生移植肾缺血,及时准确判断原因和及时恢复血供,与移植肾的存活率密切相关。
Objective To investigate the diagnosis and treatment of acute renal transplantation ischemia in renal transplantation. Methods The clinical data of 27 patients with acute renal transplantation in renal transplantation were summarized. Results The causes of renal ischemia in 27 cases of renal allograft were as follows: vasospasm in 11 cases, extrahepatic arterial spasm in 5 cases, renal vasospasm in 6 cases, renal perfusion in 6 cases, renal artery stenosis in 1 case, renal artery thrombosis 2 cases, 1 case of renal vein thrombosis, 3 cases of renal / venous torsion; 2 cases of renal artery intimal injury, 1 case of hyperacute rejection. 2 cases of renal artery / venous thrombosis thrombolytic therapy was successful. 4 cases (1 case of renal artery stenosis, 1 case of renal artery thrombosis, 2 cases of renal artery intimal injury) were transplanted transplanted renal secondary perfusion and anastomosis. One case of hyperacute rejection was confirmed by pathology after resection. The remaining cases by anticoagulant, spasm, blood pressure, adjust the location of the kidney graft and other treatment to ease. One patient was excluded due to acute rejection and graft rupture. In the remaining 25 cases, 22 cases of human kidney survived well, and 3 cases of transplant kidneys were impaired due to chronic graft nephropathy. Tubal necrosis occurred in 8 cases. Four patients were acutely rejected, and three were reversed after treatment with methylprednisolone or anti-thymocyte globulin (ATG). Conclusions Transplantation of renal ischemia occurs during renal transplantation, and timely and accurate diagnosis of the causes and timely recovery of blood supply is closely related to the survival rate of renal allografts.