活体供肾肾移植的血管应用解剖

VASCULAR ANATOMY OF DONOR AND RECIPIENT IN LIVING KIDNEY TRANSPLANTATION

目的总结活体供肾肾移植供受体的有关血管解剖。方法查阅近年有关亲属移植供受体血管解剖的国内外文献,并进行综述。结果供受体血管解剖对病例选择、手术方案制定及远期效果均有重要作用。供体过早分支和副肾动脉的存在常会影响手术侧、手术方式和吻合方式的选择,其损伤出血及静脉出血均是导致腹腔镜手术转开放手术的重要原因。随着腹腔镜供肾切除的增多,术前准确肾静脉评估也越来越得到重视。多层螺旋CT可代替常规影像学检查并能准确评估供肾血管、血管变异、肾病变、集合系统和其他相关解剖信息。结论详细了解供受体的肾血管解剖不仅利于手术成功,还能促进活体供肾肾移植的发展。多层螺旋CT已成为供体术前首选"一站式"影像学检查方法。

Objective To review the vascular anatomy of the donor and the recipient for the living kidney transplantation. Methods The recent literature about the vessels of donor and recipient in clinical applications was extensively reviewed. Results The pertinent vascular anatomy of the donor and recipient was essential for the screening of the proper candidates, surgical planning and long-term outcome. Early branching and accessory renal artery of the donor were particularly important to deciding the side of nephrectomy, surgical technique and anastomosing pattern, and their injuries were the most frequent factor of the conversion from laparoscopic to open surgery. With increase of laparoscopic nephrectomy in donors, accurate venous anatomy was paid more and more attention to because venous bleeding could also lead to conversion to open nephrectomy. Multidetector CT （MDCT） could supplant the conventional excretory urography and renal catheter angiography and could accurately depict the donors＇ vessels, vascular variations. In addition, MDCT can excellently evaluate the status of donor kidney, collecting system and other pertinent anatomy details. Conclusion Accurate master of related vascular anatomy can faciliate operation plan and success of operation and can contribute to the rapid development of living donor kidney transplantation. MDCT has become the choice of preoperative one-stop image assessment for living renal donors.