大隐静脉逆转代替髂外动脉治疗肾移植术后血管并发症(附2例报告)
Replacement of external iliac artery by reversed great saphenous vein for the treatment of vascular complications after renal transplantation: a report of 2 cases
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摘要: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。Abstract:Objective To investigate the treatment of vascular complications after renal transplantation and the replacement therapy of blood vessels in an emergency.Method Two patients with repeated external iliac artery bleeding after renal transplantation received treatment in Transplantation Center of the Third Xiangya Hospital of Central South University from December 2009 to March 2012. After surgical exploration, the reason of bleeding was burst of the anastomotic external iliac artery in two cases. Then anastomotic external iliac artery was removed and the ipsilateral autologous limb's great saphenous vein was taken for reversed replacement of external iliac artery.Result Both patients recovered well after the operation with normal lower limb blood supply and free walk. One patient survived for four years with no postoperative bleeding again. Another patient had recovered for more than one year with normal the lower limb blood supply.Conclusion Repeated external iliac artery rupture hemorrhage after renal transplantation is one of the serious complications which results in death. Emergency treatment is very important and autologous vascular reconstruction may be a more effective and convenient treatment.
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