以肾移植受体腹壁下动脉重建移植肾副肾动脉的临床应用

Clinical application of reconstructing allograft accessory renal artery with recipient inferior epigastric artery in kidney transplantation

目的 探讨以受体腹壁下动脉(inferior epigastric artery, IEA)重建移植肾副肾动脉(accessory renal artery,ARA)的临床应用价值.方法 26只移植肾中16只为单支型ARA,10只为多支型整形后余留单支型ARA;ARA位于上极12支,中部4支,下极10支;开口直径1.5～3.5mm;用亚甲蓝灌注显示动脉血供范围.行ARA与受者IEA端-端吻合,其中6例上极ARA过短,将移植肾上下位置翻转后吻合.结果 26例均吻合成功,再通血流后移植肾ARA供血范围血供恢复良好.术后3d,多普勒超声检查显示:21例局部血流正常; 5例局部动脉阻力指数增高,至术后15～21d恢复正常.本组受者术后3d内血清肌酐和肌酐清除率与同期对照组相比差异无统计学意义(P＞0.05),随访6个月,无输尿管坏死和局部动脉栓塞发生.结论 应用受体IEA可以重建移植肾ARA,血管吻合过程不影响肾功能恢复,适用于ARA与肾动脉主干或其他动脉吻合存在困难的患者.

Objective To explore the significance of reconstructing allograft accessory renal artery(ARA) with recipient inferior epigastric artery(IEA) in kidney transplantation.Methods Twenty-six cases of ARA were presented.Of which,upper polar type was in 12,middle in 4 and lower polar in 10.The surface area of ARA blood supply was identified with the perfusion of methylene blue.Reconstruction of ARA was made by anastomosing ARA to recipient IEA.Results ARA-IEA anastomosis was completed in all cases.Blood circulation of the allografts supplied by ARA was restored immediately after releasing the clamps to IEA.Normal blood circulation was showed in 21 grafts while increased artery resistance index was found in the region of ARA supply in the other 5 cases by Doppler ultrasound on 3d postoperatively,which did not recovered until 15-21d after operation.The level of serum creatinine and creatinine clearance in the recipients with ARA reconstruction was comparable to that of the recipients with normal allografts during the first 3d postoperatively.No artery occlusion and ureteral necrosis were found in the recipients within a 6-month follow-up.Conclusion IEA is a choice for reconstructing allograft ARA to which there is difficulty in reconstructing with other arteries.