全机器人自体肾移植术治疗肾门部复杂动脉瘤1例报告并文献复习

Robot-assisted kidney autotransplantation for complex artery aneurysm of renal hilum-one case report and literature review

目的:探讨机器人辅助腹腔镜肾脏切取、离体肾动脉瘤切除重建、机器人辅助自体肾移植技术治疗复杂性肾动脉瘤的安全性和可行性。方法:经CT血管造影三维重建确诊右肾动脉瘤1例,病变位于肾动脉主干末端分叉处,深入肾门,五支二级分支动脉均自瘤体发出。完善各项术前评估,对患者行机器人辅助腹腔镜右肾切取、右肾动脉瘤离体切除重建、机器人辅助自体肾移植术。结果:手术顺利,术后第1天血肌酐99.1μmol/L,连续监测血肌酐值正常,于术后第7天出院。术后3个月复查,移植肾动脉管腔正常,血流动力学稳定,肾功能良好。结论:机器人辅助腹腔镜肾脏切取、离体肾动脉瘤切除重建、机器人辅助自体肾移植技术治疗肾门部复杂动脉瘤安全有效,值得进一步探索优化。

Objective:To investigate the safety and feasibility of robot-assisted laparoscopic nephrectomy with ex-vivo renal artery aneurysm(RAA)resection and reconstruction,and robot-assisted kidney autotransplantation to treat complex RAA.Methods:One patient with incidentally identified right RAA by three-dimensional computed tomographic angiography(CTA)underwent robot-assisted laparoscopic nephrectomy with ex-vivo RAA resection and reconstruction and robot-assisted kidney autotransplantation.The hilar RAA involving 5 branches was located at the bifurcation of main renal artery.Results:The operation was done successfully.The serum creatine was 99.1μmol/L at 1 st day after operation and remained normal continuously.The patient was discharged on the postoperative day 7.At follow-up of 3 months,imaging demonstrated normal caliber of the reconstructed renal artery with good hemodynamics and renal function preserved.Conclusions:This minimally invasive operation may be considered significantly as a safe and effective surgical technique to treat complex hilar RAA.Larger experiences with longer follow-up are necessary for further optimization.