CAJ | 학술논문

目的探讨移植肾动脉瘤(RAA)的病因、诊断及治疗. 方法 1998年8月至2004年12月共行同种异体肾移植手术1251例,发生RAA 5例(0.4%).5例均为男性,平均年龄43岁,移植肾血管吻合方式均为移植肾动脉一髂内动脉端端吻合.患者主要临床表现为进行性肾功能减退,突发少尿或无尿,顽固性高血压及肾区疼痛,均经彩色多普勒超声、数字减影血管造影检查确诊为动脉瘤,动脉瘤大小1.8 cm×2.0 cm×2.0 cm～4.0 cm×4.0 cm×5.0 cm. 结果移植肾动脉吻合口动脉瘤2例,1例发现动脉瘤后1个月内移植肾功能丧失,行移植肾切除术,术后规律透析治疗,随访1年后行二次肾移植;1例移植肾失功后1周内行对侧髂窝二次肾移植手术,保留原移植肾,术后随访2年肾功能正常.RAA合并近端移植肾动脉狭窄2例,1例行吻合口球囊扩张并放置支架后,以弹簧螺圈栓塞动脉瘤,术后随访1年肾功能稳定;1例行移植肾切除、二次.肾移植术,术后随访3年肾功能正常.吻合口髂内动脉侧粥样硬化斑块导致髂内动脉狭窄、移植肾动脉侧动脉瘤1例,行移植肾切除术,术后2 d因脑干栓塞死亡. 结论移植肾动脉-髂内动脉端端吻合易诱发血管并发症,RAA治疗应谨慎采用开放手术切除,可选择近期行二次肾移植和血管内介入治疗.
목적 탐토이식신동맥류(RAA)적병인、진단급치료. 방법 1998년8월지2004년12월공행동충이체신이식수술1251례,발생RAA 5례(0.4%).5례균위남성,평균년령43세,이식신혈관문합방식균위이식신동맥일가내동맥단단문합.환자주요림상표현위진행성신공능감퇴,돌발소뇨혹무뇨,완고성고혈압급신구동통,균경채색다보륵초성、수자감영혈관조영검사학진위동맥류,동맥류대소1.8 cm×2.0 cm×2.0 cm～4.0 cm×4.0 cm×5.0 cm. 결과 이식신동맥문합구동맥류2례,1례발현동맥류후1개월내이식신공능상실,행이식신절제술,술후규률투석치료,수방1년후행이차신이식;1례이식신실공후1주내행대측가와이차신이식수술,보류원이식신,술후수방2년신공능정상.RAA합병근단이식신동맥협착2례,1례행문합구구낭확장병방치지가후,이탄황라권전새동맥류,술후수방1년신공능은정;1례행이식신절제、이차.신이식술,술후수방3년신공능정상.문합구가내동맥측죽양경화반괴도치가내동맥협착、이식신동맥측동맥류1례,행이식신절제술,술후2 d인뇌간전새사망. 결론 이식신동맥-가내동맥단단문합역유발혈관병발증,RAA치료응근신채용개방수술절제,가선택근기행이차신이식화혈관내개입치료.
ObJective To discuss the causes,diagnosis,treatment and outcomes of renal artery aneurysm(RAA). Methods Duriog August 1998 and December 2004,1251 patients underwent rehal transplantation,and 5 men(mean age,43)who received end-to-end anastomose from renal graft artery to the internal iliac artery were found to develop RAA.The main complains included aggravated renal function,sudden oliguria or anuria,hypertension and allograft pain.Color Doppler flow and digital subtraction angiography were used to confirm aneurysm.Size of the RAA were 1.8 cm×2.0 cm×2.0 am to 4.0 cm×4.0 cm×5.0 cm. Results Two aneurysms were located at the anastomotic stoma.One patient who lost renal function 1 month after the aneurysm was diagnosed received nephrectomy,regular hemodialysis,and another renal transplantation 1 year later.The other patient successfully underwent cadaver transplantation without removing the original renal allograft after the renal dysfunction occurred.The renal function remained normal during 2 years'follow-up.Two renal artery aneurysm cases also accompanied with proximate renal artery stenosis.One patient was treated with balloon dilatation and stent implantation,and normal renal function was observed during 1 years followup. Another patient had graft removed and underwent retransplantation.The renal function was excellent during 3 years'follow-up.Atherosclerotic plaque within internal iliac artery anastomotic stoma,which lead to artery stenosis and aneurysm,was found in 1 patient.Two days after the renal allograft was removed,this patient died of brainstem embolism. Conclusions End-to-end anastomose from renal graft artery to the internal iliac artery seems to be related with postoperative complications.Patients with confirmed RAA should be cautiously managed.Retransplantation and interventional thera PY may be the choice.