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在肾移植中,常会遇到供受者动脉病变及多支血管变异,如处理不当,常导致移植肾失败或肾功能不全.本院共施行肾移植350例,其中受者髂内动脉严重粥样斑块硬化、管腔接近闭塞者30例,供肾多支动脉变异36例,供肾动脉与髂内动脉管径悬殊较大8例,均作了合理的处理.术后移植肾血供良好,1年后随访,吻合血管通畅,肾功能正常,现将其处理经验介绍如下.1 处理方法1.1 髂内动脉严重粥样斑块硬化的处理髂内动脉管腔很小,接近闭塞.这种髂内动脉如与肾动脉吻合,开放血流后移植肾常供血不足,肾色虽鲜艳,但充盈张力差,术后常发生急性肾衰及无尿,导致肾移植失败.对此,我们有沉痛的失败教训.后来我们对25例粥样斑块硬化患者采取髂内动脉斑块切除,然后与肾动脉作端端吻合,开放血流后移植肾充盈张力良好.对5例斑块不能切除者,采取肾动脉与髂外动脉端侧吻合,同样取得良好效果.术后随访1年,肾功能正常,肾动脉无血管杂音,B超、彩色多普勒血流图、肾动脉造影(部分患者)未发现异常变化.
In renal transplantation, often encountered donor artery disease and multivessel variability, such as improper handling, often lead to graft failure or renal insufficiency in our hospital a total of 350 cases of renal transplantation, in which recipients of severe internal iliac artery porridge Such as plaque sclerosis, lumen close to obstruction in 30 cases, 36 cases of multiple branch artery grafting, renal insufficiency and internal iliac artery larger diameter in 8 cases, were made a reasonable treatment. Good, follow-up after 1 year, anastomosis of vascular patency, normal renal function, now the treatment experience described below .1 treatment 1.1 severe internal carotid artery atherosclerosis treatment of internal iliac artery lumen is very small, close to occlusion. If the internal iliac artery anastomosis with the renal artery, open blood flow often lack of donor kidney graft, although the bright kidney color, but poor filling tension, postoperative acute renal failure often occurs and anuria, resulting in failure of renal transplantation. In this regard, we There is a painful lesson of failure.And later we 25 cases of atherosclerotic plaques in patients with internal iliac artery plaque removal, and then end-to-end anastomosis with renal artery, open the blood flow after transplantation of renal filling tension good .For 5 cases can not plaque Excision, to take the renal artery and external iliac artery anastomosis, the same Get good results. Patients were followed up for 1 year with normal renal function, renal artery no bruit, B ultrasound, color Doppler flow imaging, renal arteriography (some patients) found no abnormal changes.