体外重建受损或畸形肾血管在肾脏移植中的应用.doc

体外重建受损或畸形肾血管在肾脏移植中的应用 　　作者：吴建臣，管德林，张志宏，黄 真，赵 勇，钱玉松，李胜文 作者单位：清华大学第一附属医院泌尿外科，北京 100016 　　【摘要】 　　目的 探讨体外修复重建受损或畸形供肾血管对肾脏移植临床效果的影响。方法 对11例供肾有血管损伤或畸形的肾移植资料进行回顾性分析，并以同期进行的20例正常供肾肾移植病例作为对照组。体外血管重建的方法包括动脉端端吻合(3例)、端侧吻合(3例)、侧侧共干吻合(2例)、利用供体或受体髂动脉及其分支合并及延长供肾动脉(3例)。结果 术后平均随访2年，两组患者均存活;血管重建组2例而对照组3例患者术后新出现高血压或高血压加重(P=0.595)，但未发现移植肾动脉狭窄;血管重建组和对照组术后肾功能延迟恢复发生率为27.3%和20%(P=0.484)，急性排斥反应发生率分别为9.1%和10.0%(P=0.719);术后1年两组内有移植肾患者的血肌酐水平分别为(110±21)和(107±23)Μmol/L(P=0.664)，两组间差异无显著性。结论 选择合适方法进行体外修复重建供肾受损或畸形的血管，不会影响肾移植的效果，并可以大大提高供体器官的利用率。 　　【关键词】 肾移植 血管畸形 外科手术 　　Ex situ reconstruction of damaged or malformed renal blood vessels before kidney transplantation 　　Wu Jianchen, Guan Delin, Zhang Zhihong, Huang Zhen, Zhao Yong, Qian Yusong, Li Shengwen 　　(Center of Urology, First Hospital of Tsinghua University, Beijing 100016, China)ABSTRACT: Objective To study the techniques and outcomes of ex situ reconstruction of damaged or malformed renal blood vessels before kidney transplantation. Methods 11 patients treated with transplantation of allogenetic kidneys with damaged or malformed blood vessels from April 2004 to April 2007 were retrospectively reviewed. 20 patients transplanted with normal kidney during the same period were selected as control group. Bench surgery with microsurgical techniques was employed for the repair of the vessels, which included 3 cases of end to end anastomosis of arteries, 3 cases of end to side anastomosis of arteries, 2 cases of side to side conjoined anastomosis of arteries, and 3 cases of renal artery lengthening with an interposition of donor or recipient iliac artery. The renal vein was anastomosed to the external iliac vein and the renal artery to the internal iliac artery. The ureter was implanted using an extravesical technique. Triple immunosupression was used. Results Average followup was 2 years. There were no death occurred in both groups. No arterial stenosis occurred during the followup. The incidence of delayed graft function was 2