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目的探讨肾移植术后血管并发症的处理及在紧急状态下替代血管治疗的应用。方法中南大学湘雅三医院移植中心于2009年12月至2012年3月收治了两例肾移植术后反复髂外动脉出血的患者。两例手术探查出血为原髂外动脉吻合口处有破溃,给予切除移植动脉吻合口处的髂外动脉,取同侧自体下肢的大隐静脉逆转替代切除的髂外动脉。结果两例患者术后均恢复良好,下肢血运正常,行走自如,其中1例患者存活至今达4年,术后未再次出血;另1例患者手术后已愈1年余,下肢血运正常。结论肾移植术后反复髂外动脉破裂出血是导致患者死亡的严重并发症之一,紧急处理非常重要,采用自体血管重建不失为一种较有效和便捷的处理方法。
Objective To investigate the treatment of vascular complications after renal transplantation and the application of alternative vascular treatment in emergency. Methods The Second Affiliated Hospital of Xiangya Third Hospital of Central South University from December 2009 to March 2012, two patients with repeated external iliac artery hemorrhage after renal transplantation were treated. Two cases of surgical exploration of bleeding for the original external iliac artery anastomosis at rupture, giving resection of the external iliac artery at the anastomotic graft, take the ipsilateral autologous lower limb saphenous vein to reverse the replacement of the resection of the external iliac artery. Results Both of the two patients recovered well after operation, and the blood flow was normal and the lower limbs walked freely. One patient survived for up to 4 years now and did not hemorrhage after operation. The other one had more than one year after surgery and blood flow was normal . Conclusion Repeated external iliac artery rupture and hemorrhage after renal transplantation is one of the serious complication caused by the death of patients. Emergency treatment is very important. Autologous vascular reconstruction is a more effective and convenient treatment.