基于人工血管置换术治疗肾移植术中髂外动脉夹层的临床效果研究  

Clinical efficacy of artificial vascular replacement for external iliac artery dissection during renal transplantation

作　　者：张江伟 李杨[1] 田普训[1] 丁晨光[1] 郭挺 郑瑾[1] 郝琳 李潇 丁小明[1] Zhang Jiangwei;Li Yang;Tian Puxun;Ding Chenguang;Guo Ting;Zheng Jin;Hao Lin;Li Xiao;Ding Xiaoming(Department of Renal Transplantation,First Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肾移植科,西安710061

出　　处：《中华器官移植杂志》2022年第4期211-214,共4页Chinese Journal of Organ Transplantation

基　　金：西安交通大学第一附属医院3D打印医学研究奖(XJTU1AF-3D-2018-001)。

摘　　要：目的探究通过人工血管置换术治疗肾移植术中髂外动脉夹层的临床效果。方法选取2015年1月至2021年5月西安交通大学第一附属医院肾移植科应用人工血管置换术治疗肾移植术中髂外动脉夹层4例,男性3例,女性1例,年龄28~55岁。4例肾移植受者均为术中突发髂外动脉夹层,拆除血管缝合线发现动脉内膜剥脱堵塞髂外动脉3例,堵塞移植肾动脉1例,使用膨体聚四氟乙烯(ePTFE)制成的人工血管,行髂外动脉的人工血管置换术。4例受者移植肾行二次灌注,改与髂内动脉吻合。结果1例受者术后1周肾功血肌酐恢复正常,2例发生移植肾功能延迟恢复,1例发生移植肾功能延迟合并急性排斥反应,给予血液透析治疗,术后2~3周血肌酐恢复正常。随访时间0.5~5.0年,移植肾功能稳定,术侧下肢血供及皮温正常,活动有力自如。结论肾移植术中髂外动脉血管夹层发生率不高,但病情进展迅速且凶险,如不及时处理后果严重,通过人工血管置换术治疗肾移植术中髂外动脉夹层可取得比较满意的临床效果。Objective To explore the clinical efficacy of treating external iliac artery dissection in renal transplantation by artificial vascular replacement.Methods Four sudden intraoperative cases of external iliac artery dissection were selected.After removing vascular sutures,intimal arterial peeling blocked external iliac artery(n=3)and transplanted renal artery(n=1).Artificial vascular replacement of external iliac artery was performed using artificial vessels made from puffed polytetrafluoride ethylene(ePTFE).Secondary perfusion was performed in four transplanted kidneys for anastomosing with internal iliac artery.Results One patient regained normal renal function within 1 week post-operation.Two cases had delayed graft function.Another case had delayed graft function plus acute rejection.After hemodialysis,renal function normalized at 2-3 weeks post-operation.During a follow-up period of(0.5-5.0)years,transplanted kidney function remained stable,blood supply,skin temperature and movement of operated lower extremities normalized.Conclusions The incidence of vascular dissection of external iliac artery is not high during renal transplantation.However,the disease has a rapid and dangerous progression.The consequences of delayed intervention are quite serious.Treating external iliac artery dissection with renal transplantation may achieve satisfactory clinical outcomes.

关 键 词：肾移植 移植后血管并发症 人工血管置换术 

分 类 号：R699.2[医药卫生—泌尿科学]