移植肾动脉血栓形成7例次临床分析  

Clinical analysis of kidney artery thrombosis in patients with renal transplantation

作　　者：韩志友[1] 张勇[1] 张愚[1] 管德林[1] 

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,北京100020

出　　处：《肾脏病与透析肾移植杂志》2004年第2期137-140,共4页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的 :探讨移植肾动脉血栓形成的相关危险因素、诊断和治疗。　 方法 :回顾性分析 7例次肾移植术后移植肾动脉血栓形成患者的凝血机制、并发症、手术方式、血栓发生时间、诊断和治疗方式及其预后。　 结果 :16 32例次肾移植患者中发生肾动脉血栓 6例 (7例次 ) ,发生率为 4 3‰。 5例次血栓发生在术后 12h至 7天 ;2例次发生在术后 18个月和 2 4个月。患者表现为尿量减少 ,彩色多谱勒超声和血管造影协助诊断。 2例次患者溶栓成功 ;1例次患者手术取栓成功 ;4例次患者因动脉血栓造成移植肾不可逆的病理改变而切除移植肾。 3例次受者手术前后的凝血酶原时间较正常明显缩短 ,处于高凝状态。　 结论 :移植肾动脉血栓多发生在术后早期 ,受者高凝尤应警惕。Objective:To analyze the risk factors, diagnosis, therapy and prevention of transplanted kidney artery thrombosis. Methodology:Six patients, one female and five males, age from 13 to 65 years old, were studied. Among them, five had cadaver donors and one had living donor. One male patient suffered twice graft artery thrombosis. Prothrombin time (PT), urine volume, the method of operation, the occurring time of thrombosis after transplantation (T thrombosis), diagnosis, therapy and prognosis of the grafts artery thrombosis were retrospectively analyzed. Results:Six patients (4.3‰) suffered graft artery thrombosis in 1 632 cases with kidney transplantation in our hospital from 1991 to 2003. The occurring time of thrombosis was from 12 hours to 7 days after operations in five patients and from 18 months and 24 months after transplantation in two cases. Two patients were received successful thrombolysis by interventional therapy. The embolus was taken out from one patient by re-operation. The transplanted kidneys were cut off in four patients because of thrombosis. Among them, one patient had Mucoraceae confirmed by biopsy of thrombus, one patient with atherosclerosis of internal iliac artery was stripped of tunica intima before anastomosis. The prothrombin time of three patients was shorter than patients without the grafts artery thrombosis. All of patients had uropenia or anuria or urinary volume decreasing suddenly after operation. Conclusions:The grafts artery thrombosis usually occurred in early period after transplantation. The shorter prothrombin time of patients were more likely to suffering the grafts artery thrombosis. When uropenia or anuria occurred in patients after transplantation, acute rejection as well as the graft artery thrombosis should be considered. To differentiate between rejection and the graft artery thrombosis, ultrasonography was a simple and reliable method. The angiography was the golden standard for diagnosis, and interventional therapy can be done at the same time. Thrombolysis b

关 键 词：移植肾 动脉血栓形成 溶栓治疗 肾移植 临床资料 

分 类 号：R699[医药卫生—泌尿科学]