论文部分内容阅读
目的探讨肾移植术后血管并发症的特点和诊治方法。方法回顾34例术后并发血管疾病的肾移植患者临床资料,对其发病特点和诊治方法进行分析总结。结果34例患者中,并发移植肾动脉梗阻13例,移植肾动脉出血8例,动脉吻合口破裂7例,移植肾静脉梗阻4例,髂外动脉瘤和髂外静脉栓塞各1例。21例经彩色多普勒血流显像(CDFI)作出诊断,其中10例进一步行磁共振血管成像(MRA)明确诊断。5例移植肾动脉狭窄患者中,3例放置血管内支架扩张后肾功能恢复良好,分别随访8、10、14个月,血肌酐维持在115~135μmol/L;1例将与髂内动脉端端吻合的移植肾动脉改为与髂外动脉端侧吻合,术后至今1个月,血肌酐降至正常水平;1例MRA显示不完全狭窄,给予保守治疗,至今观察21d,血肌酐持续降低。3例静脉梗阻患者经手术解除梗阻,其中1例死于心力衰竭,另2例随访13、36个月,肾功能恢复良好。1例髂外静脉栓塞患者术后死于移植肾破裂。其余患者均切除移植肾。结论肾移植术后的血管并发症进展迅速,应根据具体情况及时采取相应治疗手段,处理不及时往往导致移植肾功能丧失,因此早期诊断非常重要,CDFI可作为首选筛查手段。
Objective To investigate the characteristics and diagnosis and treatment of vascular complications after renal transplantation. Methods The clinical data of 34 cases of postoperative renal transplant recipients with vascular diseases were retrospectively analyzed, and their characteristics of onset and diagnosis and treatment were analyzed and summarized. Results Thirty-four patients were complicated with renal artery obstruction in 13 cases, transplantation of renal artery bleeding in 8 cases, arterial anastomotic rupture in 7 cases, transplantation of renal vein obstruction in 4 cases, external iliac artery aneurysm and external iliac embolization in 1 case. 21 cases were diagnosed by color Doppler flow imaging (CDFI), of which 10 cases were further diagnosed by magnetic resonance angiography (MRA). Of the 5 patients with renal artery stenosis, the renal function recovered well after stent placement in 3 cases, and the serum creatinine was maintained at 115 ~ 135μmol / L at 8, 10, and 14 months of follow-up. One case was associated with internal iliac artery End-to-end anastomosis of graft renal artery end to side with external iliac artery anastomosis, 1 month after surgery, serum creatinine dropped to normal levels; 1 case of MRA showed incomplete stenosis, given conservative treatment, so far observed 21d, serum creatinine continued to decrease . Three patients with venous obstruction were surgically removed, one died of heart failure and the other two patients were followed up for 13 and 36 months. Renal function recovered well. One patient with external iliac embolization died of renal allograft rupture. The remaining patients were allograft. Conclusions Vascular complications after renal transplantation are progressing rapidly. Corresponding treatment should be taken according to the specific circumstances. If the treatment is not timely, it often leads to the loss of renal function. Therefore, early diagnosis is very important. CDFI can be used as the primary screening method.