自体肾移植治疗肾动脉狭窄介入治疗后再狭窄:3例报告

Autotransplantation of kidney for renal artery restenosis after the interventional therapy in 3 patients

目的:肾动脉狭窄可以导致肾血管性高血压和缺血性肾病,是慢性肾功能衰竭的主要原因之一。观察自体肾移植术在肾动脉狭窄及介入治疗后再狭窄中的应用效果。方法:选择2003-12/2006-10北京中医药大学东直门医院泌尿科收治的自体肾移植治疗肾动脉狭窄介入治疗失败或再次出现狭窄的年轻患者3例,均为男性,平均年龄14岁,患者及其监护人对治疗方案均知情同意。两例年龄较大的患者采用腹膜外入路,另1例经腹腔切取肾脏。肾脏均植于同侧髂窝,两例采用肾动脉与髂内动脉端端吻合,1例切取髂内动脉与左肾动脉吻合,将延长的左肾动脉与髂外动脉行端侧吻合;3例均行肾静脉与髂外静脉端侧吻合,输尿管与膀胱隧道式吻合。采用门诊方式随访,观察手术对患者血压、肾功能的影响。结果:3例患者手术成功率为100%,未发生术后并发症;术后2周内血压均恢复正常,随访9￣36个月移植肾功能良好。结论:自体肾移植治疗肾动脉狭窄介入治疗失败或再次出现狭窄手术成功率高,无并发症发生。肾动脉狭窄介入治疗后再狭窄及患多发性大动脉炎的年轻患者可选择自体肾移植术。

AIM： Renal artery stenosis can cause renal vascular hypertension and ischemic nephropathia and is one of the chronic renal failure （CRF）. This article is designed to observe the application of the autotransplantation of kidney in the renal artery stenosis and the restenosis after interventional therapy. METHODS： Three male patients, who had failure interventional therapy of autotransplantation of kidney for renal artery stenosis or renal artery restenosis, were enrolled from Department of Urology, Dongzhimen Hospital, Beijing University of Chinese Medicine from December 2003 to October 2006. Their mean age was 14 years. The patients and their guardians signed the informed consent. Two older patients received extraperitoneal approach. Kidney of another one was cut out through abdominal cavity. Kidney was implanted in iliac fossa at the same side. Two received renal artery and internal iliac artery end-to-end anastomosis, while one received internal iliac artery and left renal artery, and the prolonged left renal artery and external iliac artery received end-to-side anastomosis. The three patients received renal vein and external iliac vein end-to-side anastomosis as wall as ureter and bladder tunnel anastomosis. Follow-up was performed by means of out-patient clinic to observe the effect of operation on patients＇ blood pressure and renal function. RESULTS： Technical success was achieved in the three patients without complication. All patients experienced a normal blood pressure in two weeks after operation. All patients experienced a normal renal function in 9-36 months follow-up. CONCLUSION： The operation has high achievement ratio in patients with failure interventional therapy of autotransplantation of kidney for renal artery stenosis or renal artery restenosis. Patients with the renal artery restenosis after the interventional therapy or young patients with polyarteritis can be performed with the autotransplantation of kidney.