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目的:本研究应用钛轮钉血管吻合器作肾移植动脉重建术,以确定其能否快捷而安全地完成大血管吻合。方法:75例因慢性肾衰而接受同种异体肾移植病人,36例采用血管吻合器行供肾动脉与髂内动脉端端吻合术,另39例采用间断缝合端端吻合肾动脉与髂内动脉。然后比较分析两组的动脉吻合时间,血管阻断时间,整个手术时间和血管并发症。结果:钛轮钉吻合移植肾动脉全部成功。钛轮钉的动脉吻合时间为(7.0±6.1)min,缝合组是(16.1±7.2)min(P<0.01),血管阻断时间分别为(17.8±6.0)min,(28.1±6.8)min(P<0.05);手术总时间分别为(2.2±0.9)h,(2.5±1.2)h(P>0.05)。用2mm钛轮钉,2只肾下极动脉与腹壁下动脉吻合成功。手术无1例大出血而重新吻合,吻合口通常率达到100%。61例获得随访,随访时间2~5年。吻合器组发生移植肾动脉狭窄1例,而缝合组有3例出现此并发症。结论:血管吻合器吻合血管安全、简便、快捷,血管外翻吻合,内膜对合平整。应用此技术吻合动脉可缩短热缺血时间,降低肾动脉狭窄的发生,因此可提高肾移植效果。
OBJECTIVE: In this study, titanium-titanium staple vascular stapler was used for renal artery graft reconstruction to determine whether it can quickly and safely complete large vessel anastomosis. Methods: Thirty-five patients with renal allograft due to chronic renal failure were enrolled. Thirty-six patients underwent endo-anastomosis of the renal artery and internal iliac artery with a vascular stapler, and the other 39 patients received anastomosis interrupted sutured renal artery and internal iliac artery artery. Then compared the two groups of arterial anastomosis time, vascular occlusion time, the entire operation time and vascular complications. Results: Titanium nail anastomosis allograft renal artery success. The mean arterial anastomosis time was (7.0 ± 6.1) min for titanium wheel staples and (16.1 ± 7.2) min for suture group and (17.8 ± 6.0) min for (28.1 ± 6.8) min P <0.05). The total operation time was (2.2 ± 0.9) h and (2.5 ± 1.2) h respectively (P> 0.05). With 2mm titanium wheel nail, two renal inferior anastomosis and abdominal artery anastomosis successfully. No major bleeding in surgery and re-anastomosis, anastomosis usually rate of 100%. 61 cases were followed up for 2 to 5 years. One case of renal artery stenosis occurred in the stapler group, while three cases in the suture group had this complication. Conclusion: Vascular stapler anastomosis blood vessels safe, simple, quick, vascular eversion anastomosis, endometrial coalescence. Application of this technique consistent with arteries can shorten the warm ischemia time and reduce the occurrence of renal artery stenosis, it can improve renal transplantation.