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目的探讨肾动脉多支畸形的供肾在体外血管重建中的方式及其在肾移植中的应用。方法对5例肾动脉多支畸形供肾的修整采取截取受者同侧髂内动脉的方法,依据供肾动脉的分支数而保留髂内动脉的分支数;在体外将供肾动脉各分支与髂内动脉大分支的开口进行端端吻合,然后将髂内动脉主干与受者髂外动脉行端侧吻合。将肾动脉重建后的供肾应用于双侧肾动脉瘤患者的自体肾移植术1例、亲属活体供肾肾移植术3例和尸体肾移植术1例。结果术后5例受者均未发生外科并发症。1例术后发生短暂的急性肾小管坏死,但48h后进入多尿期,肾功能恢复顺利。术后随访10～36个月,受者移植肾功能全部正常,肾动脉及分支未发生血栓或闭塞。结论采用受者的髂内动脉体外重建供肾动脉的方法,可有效修复肾动脉3支以上以及肾动脉过短的供肾,是一种安全可行的血管重建的方法,血管并发症较低,可有效应用于肾移植。
Objective To investigate the way of donor kidney with multiple deformities of renal artery in vascular revascularization and its application in renal transplantation. Methods A total of 5 renal arteries with multiple deformities for the repair of the kidneys were intercepted by the ipsilateral iliac artery, and the number of branches of the internal iliac artery was reserved according to the number of branches of the renal arteries. In vitro, The opening of the large internal iliac artery branches end to end anastomosis, and then the internal iliac artery and recipient external iliac artery anastomosis. One case of autologous renal transplantation in renal artery aneurysm patients and one case of renal donor kidney transplantation in 3 cases and kidney transplantation in cadaver were retrospectively analyzed. Results No postoperative complications occurred in 5 patients. Acute postoperative acute tubular necrosis occurred in one case, but after 48 hours, it entered the polyuria stage and the renal function recovered smoothly. All cases were followed up for 10 to 36 months. All the recipients had normal renal allograft function. No thrombosis or occlusion occurred in the renal arteries and branches. Conclusion Recipient of the internal iliac artery for reconstruction of the renal artery in vitro method can effectively repair the renal artery more than 3 and the renal artery is too short for the kidney, is a safe and feasible method of revascularization, lower vascular complications, Can be effectively used in kidney transplantation.