论文部分内容阅读
目的探讨活体肾移植供肾多支血管的处理及重建方法。方法 49例供体,供肾有多支动脉变异45例,有多支静脉变异7例,其中3例为肾动脉、静脉同时多支血管变异。供肾切取术中,对于供血面积直径小于3cm且影响操作的分支动脉,术中即予结扎、离断;多支静脉,如直径为主干的1/3以下且试夹闭该静脉未发现明显淤血等血液回流障碍者,给予结扎、离断。5例采用体外血管重建。受体肾移植术中根据分支动脉管径、长度及位置及受者髂动脉和腹壁下动脉的情况等综合条件来选择受者相应的动脉吻合。结果 48例动脉分支吻合者在开放血流后搏动良好、吻合口通畅,术后1～7d内肾功能恢复正常、术后1～2周彩色多普勒超声检查,提示该分支动脉供血区域丰富。肾静脉分支结扎者未发现淤血现象。1例高龄供肾者发生肾功能延迟恢复。术后无出血、肾动脉栓塞、尿瘘、输尿管坏死和新发高血压等并发症。结论正确处理移植肾多支血管变异,可获得良好移植效果。
Objective To investigate the treatment and reconstruction of multiple renal vessels in living donor kidney transplantation. Methods Forty-nine donors were divided into three groups: multiple branches of arteries in 45 cases, multiple branches of veins in 7 cases, of which 3 cases were renal arteries and veins. Nephrectomy, for the blood supply area diameter less than 3cm and affect the operation of the branch artery, intraoperative ligation and rupture; multiple branches, such as the diameter of the backbone of 1/3 and try to clamp the vein was not significantly Congestion and other blood reflux disorder, to give ligation, off. Five patients underwent revascularization in vitro. Recipient renal transplantation in accordance with the diameter of the branch artery, length and location of the recipient and the iliac artery and abdominal artery under the conditions such as the overall conditions to choose the recipient corresponding arterial anastomosis. Results 48 cases of arterial branch anastomosis after open blood flow pulsating well, anastomotic patency, within 1 ~ 7d after renal function returned to normal, 1 ~ 2 weeks after color Doppler ultrasound, suggesting that the branched artery is rich in regional blood supply . Renal vein branch ligation found no congestion. One case of elderly patients with renal function delayed recovery. No postoperative bleeding, renal artery embolism, urinary fistula, ureteral necrosis and new complications such as hypertension. Conclusion Correct treatment of multi-vessel grafts in renal allografts can achieve good transplantation results.