亲属活体肾移植供肾多支动脉的重建

Reconstruction of multiple arteries of donor kidney in living related renal transplantation

背景:近年来亲属活体肾移植在国内开展增多,供肾动脉血管变异较为常见,因此需重视动脉重建的方法,以保证手术的合理性和安全性。在临床实践中发现供肾多支动脉的情况较为常见,而亲属活体肾移植国内刚刚起步,相关经验尚少。目的:总结亲属活体供肾多支动脉的血管重建方式在肾移植中的应用经验。方法:2006-01/2008-12完成38例亲属活体肾移植,其中供肾单支动脉30例,多支动脉8例。术中证实多支动脉供肾中5例供者2支动脉变异,2例供者3支动脉变异,1例供者4支动脉变异。多支动脉供肾分别采用侧侧共干吻合或端侧吻合后分别与髂内动脉或髂外动脉吻合。观察肾移植手术结果及近期随访结果。结果与结论:8例多支动脉供肾者肾移植后7～10d出院,均未输血,未出现并发症。受者肾移植后随访6～36个月,平均13个月,未见急性肾小管坏死、肾血管栓塞、肾动脉狭窄、假性动脉瘤等并发症,彩色多普勒超声检查示移植肾血供均良好。多支动脉供肾组受者吻合血管开放后泌尿时间、血肌酐水平与单支动脉供肾组差异均无显著性意义(P>0.05)。提示选择合适方法进行血管重建,不会影响肾移植效果,采用受者的髂内动脉及其分支进行血管重建安全可行。

BACKGROUND：Artery variations in living related renal transplantation occur frequently, so the methods of renovascular reconstruction should be paid more attention in order to make sure rationality and security of the surgery.In clinic, multiple arteries of the donor kidney are commonly found.Living related renal transplantation is at the early stage in China, and the related experience is few.OBJECTIVE：To discuss application of renovascular reconstruction of multiple arteries during living related donor kidney transplantation.METHODS：A total of 38 cases undergoing living related donor kidney transplantation from January 2006 to December 2008 were analyzed, including 30 cases in single renal artery group and 8 cases in multiple artery group.In multiple artery group, there were 5 cases of double arteries and 2 cases of three arteries and 1 case of four arteries.The multiple arteries were reconstructed by end to side or side to side conjoined anastomosis respectively, and then anastomosed the internal iliac artery or external iliac artery respectively.RESULTS AND CONCLUSION：No blood transfusions were needed and no complications occurred in eight cases of multiple artery donors.The 8 donors were discharged from hospital at 7-10 days postoperatively.Follow-up examinations were for 6-36 months （mean 13 months）.Renal tubule necrosis, renal artery embolism, renal pseudoaneurysm, and vascular stenosis, were not found.The color Doppler ultrasound examination showed that the transplanted kidney had good blood supply.There was no significant difference in the time of urine secretion, serum creatinine level between the multiple arteries group and the single artery group （P0.05）.These indicated that blood vessel reconstruction using a suitable method cannot affect outcomes of renal transplantation.It is feasible to reconstruct blood vessel using recipient＇s internal iliac artery and its branches.