【摘要】 目的探讨移植肾动脉栓塞治疗失功能移植肾不耐受综合征的疗效和安全性。方法回顾性分析2009年2月至2013年3月在南京医科大学第一附属医院行移植肾动脉栓塞治疗失功能移植肾不耐受综合征的12例患者的临床资料。采用改良Seldinger技术穿刺股动脉,造影观察移植肾动脉吻合方式及有否侧支循环供血。超选择性进入移植肾主要动脉分支,使用3 F Progreat微导管,首先以明胶海绵颗粒缓慢栓塞至血流明显缓慢后,其次以微弹簧圈于移植肾动脉主干内栓塞,待血流几乎停滞后再用明胶海绵颗粒加强栓塞,最后回撤导管至髂内外动脉分叉近端造影,证实移植肾动脉血流完全停滞后结束治疗。观察患者栓塞治疗的成功率。所有患者均随访3个月以上,观察有否栓塞后并发症。结果 1次栓塞治疗成功率为92%(11/12),另1例移植肾动脉栓塞治疗失败,再次行栓塞治疗后成功。患者栓塞术后住院时间4~19 d,平均9 d。随访期间,10例患者出现栓塞术后综合征,经对症治疗后短期内症状消失。所有患者栓塞术后均未出现严重并发症。结论肾动脉栓塞治疗失功能移植肾不耐受综合征安全有效。更多还原

【Abstract】 Objective To investigate the curative effect and safety of renal arterial embolization in treating the intolerance syndrome in failed renal graft. Methods Clinical data of 12 patients who received renal arterial embolization in treating intolerance syndrome in failed renal allograft in the First Affiliated Hospital of Nanjing Medical University from February 2009 to March 2013 were analyzed retrospectively. Femoral artery was punctured using modified Seldinger technique. The artery anastomosis of renal allograft and situation of collateral circulation were observed through angiography. The main renal artery branches of the renal graft were super-selectively entered with a 3 F Progreat microcatheters. Embolization was gradually performed by gelatin sponge particles till an obviously slow bloodstream was seen. After that,the micro-coils were placed in the main renal arteries. When the bloodstream nearly stopped,the gelatin sponge particles were used again to reinforce the embolization. Then the microcatheters were withdrawn to visualize the bloodstream of the near-end of joint of internal and external iliac arteries. The treatment was finished after the stangnant renal arterial bloodstream was confirmed stopped totally. The success rate of embolization was observed. All the patients were followed up over 3 months and above to observe whether there was complication after embolization. Results The success rate of one-time embolization was 92%( 11 /12). It failed in 1 case for the first time but succeeded in re-embolization after the first embolization failed. The postoperative hospital stay was 4-19 d with a mean of 9 d. During thefollow-up,10 patients suffered from post-embolization syndrome but it disappeared in a short time after symptomatic treatments. Thore was no severe complications observed in all the patients after embolization. Conclusions Renal arterial embolization in treating the intolerance syndrome in failed renal allograft is safe and effective.更多还原