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目的探讨肾移植术中血管并发症的原因及处理方法。方法总结近11年来因血管并发症而行移植肾再灌注4例,其中吻合口狭窄2例,肾静脉横断1例,动脉内膜剥脱堵塞肾动脉1例。结果4例患者术后2例恢复顺利,分别于术后第6天,第7天血肌酐恢复正常。1例术后1天即出现移植肾功能延迟恢复(DGF),术后18天血肌酐恢复正常。1例术后第3天尿量开始减少,考虑DGF,行血透及对症、支持治疗,术后第10天又合并急性排斥反应,术后31天血肌酐恢复正常。随访14月~11年,除1例于术后6年移植肾失功外,余3例现移植肾功能均正常(分别随访11年、6年、14月)。结论术中遇到移植肾缺血,首先要找出缺血原因,在排除超急性排斥反应后,应果断行再灌注,重新吻合血管,挽救移植肾。
Objective To investigate the causes and management of vascular complications in renal transplantation. Methods In the past 11 years, 4 cases of renal graft reperfusion due to vascular complications were summarized. Among them, 2 cases were anastomotic stenosis, 1 case was renal vein transection and 1 case was intima dissected. Results In 4 cases, 2 cases recovered smoothly, and serum creatinine returned to normal on the 6th day and the 7th day respectively. One case had delayed graft function (DGF) one day after operation, and serum creatinine returned to normal level 18 days after operation. On the third postoperative day, urine volume began to decrease. Considering DGF, hemodialysis and symptomatic treatment were supported. One day after operation, acute rejection occurred again. Serum creatinine returned to normal after 31 days. All patients were followed up for 14 months to 11 years. Except 1 patient who underwent transplanted renal insufficiency at 6 years after operation, the remaining 3 patients had normal renal function (11 years, 6 years, 14 months, respectively). CONCLUSION: Transplantation renal ischemia occurs during operation. First of all, it is necessary to find out the cause of ischemia. After excluding the hyperacute rejection, reperfusion should be performed resolutely to re-meet the vessel to save the graft.