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目的 探讨供肾血管损伤的处理方法 ,为临床提供参考依据。方法 回顾性分析 32例供肾血管损伤同种异体肾移植患者的资料 ,选取 6 0例同期施行肾移植非供肾血管损伤患者作为对照组。供肾血管损伤的修复方法主要包括供肾动脉端端吻合术、并接吻合术、交接吻合术、供 (受 )体髂内血管肾动脉修复术、腹壁下动脉肾动脉吻合术、供肾倒置下极肾动脉髂内动脉吻合术等。结果2 8例为肾动脉损伤 ,4例肾静脉损伤。平均体外修复手术时间 4 2min ,平均温缺血时间 31min。随访 1～ 5 (平均 3 5 )年 ,无患者死亡。供肾血管损伤组和对照组 1年移植肾存活率、术后 1年急性排斥反应、肾功能延迟恢复及血管吻合口狭窄发生率分别为 96 9% ,98 3% (P >0 0 5 ) ;12 5 % ,11 7% (P >0 0 5 ) ;2 1 9% ,18 3% (P >0 0 5 ) ;3 1% ,1 7% (P >0 0 5 )。结论 灵活、恰当地应用不同修复方法和良好的外科操作技术对保证血管损伤供肾的质量、提高利用率有重要作用。
Objective To investigate the treatment of renal vascular injury, to provide a reference for the clinical. Methods The data of 32 renal allograft recipients with renal vascular injury were retrospectively analyzed. Sixty renal transplant recipients with renal insufficiency were selected as the control group. Renal vascular injury repair methods include anastomosis for renal artery end and anastomosis, transfer anastomosis, for (by) internal iliac artery renal artery repair, abdominal artery renal artery anastomosis, inverted for the kidney Under the renal artery internal iliac artery anastomosis. Results 28 cases of renal artery injury, 4 cases of renal vein injury. The average time of in vitro repair operation 4 2min, the average warm ischemia time 31min. Follow-up 1 ~ 5 (average 35) years, no patient died. The 1-year graft survival rate, 1-year postoperative acute rejection, delayed renal function recovery and vascular anastomotic stenosis were 9%, 98 3%, respectively (P 0 05) ; 12 5%, 11 7% (P 0 05); 21 9%, 18 3% (P 0 05); 3 1%, 17% (P 0 05). Conclusions Flexible and proper application of different repair methods and good surgical techniques have an important role in ensuring the quality of the injured kidneys and improving the utilization rate of the kidneys.