Hefty T R, Nelson K A, Hatch T R, Barry J M
Renal Transplant Program, Oregon Health Sciences University, Portland.
J Urol. 1990 Jan;143(1):107-9. doi: 10.1016/s0022-5347(17)39881-6.
Renal transplantation is an accepted treatment for patients with end stage renal disease from insulin-dependent diabetes mellitus. Acute lumbosacral plexopathy developed following renal transplantation in 4 female patients with insulin-dependent diabetes mellitus between January 1, 1981 and June 30, 1988. In all 4 patients the internal iliac artery was used for revascularization of the renal allograft with ligation of the anterior and posterior divisions. Within 24 hours of surgery they complained of ipsilateral buttock pain, numbness in the leg and weakness below the knee. This complication has not been observed in nondiabetic patients at our institution, nor in diabetic patients when the internal iliac artery was not used. However, lumbosacral plexopathy occurred in 4 of 27 (14.8%) female patients with insulin-dependent diabetes mellitus when the internal iliac artery was used (p less than 0.001). Age, duration of insulin-dependent diabetes mellitus, hypertension, cigarette smoking history and kidney donor were not significant predictors of this complication. This unusual and newly recognized complication appears to result from ischemia of the lumbosacral plexus following ligation of the internal iliac artery in patients with severe small vessel disease.
肾移植是胰岛素依赖型糖尿病所致终末期肾病患者可接受的一种治疗方法。1981年1月1日至1988年6月30日期间，4例胰岛素依赖型糖尿病女性患者在肾移植后发生急性腰骶丛神经病。在所有4例患者中，髂内动脉用于肾移植的血管重建，同时结扎前后分支。术后24小时内，她们均诉说同侧臀部疼痛、腿部麻木及膝以下无力。在本机构的非糖尿病患者中未观察到这种并发症，在未使用髂内动脉的糖尿病患者中也未观察到。然而，在使用髂内动脉的27例胰岛素依赖型糖尿病女性患者中，有4例（14.8%）发生了腰骶丛神经病（P<0.001）。年龄、胰岛素依赖型糖尿病病程、高血压、吸烟史及肾脏供体并非该并发症的显著预测因素。这种不寻常且新认识到的并发症似乎是由于严重小血管疾病患者髂内动脉结扎后腰骶丛缺血所致。
