肾脏525例腹腔镜手术肾血管变异分析

Viviperception on renal vessel variation by retroperitoneal laparoscopy： a report of 525 cases

目的观察并分析腹腔镜肾脏手术肾血管变异情况，提高腹腔镜肾脏手术的安全性。方法统计北京大学第一医院泌尿外科2004年1月至2008年6月接受腹腔镜肾切除术或肾部分切除术的525例患者。其中男316例，女209例，平均年龄（58±13）岁。手术均为腹膜后途径，通过术中腹腔镜的观察和操作，对肾脏动脉、静脉的变异情况进行记录和分析。结果525例患者中有58例存在肾脏血管变异（11．0％，58／525）。18例患者单侧具有2支肾动脉（3．4％，18／525），10例患者有2支肾静脉（1．9％，10／525），1例患者有3支肾静脉，3例患者同时具有双肾动脉、双肾静脉。25例患者有副肾动脉（4．8％，25／525），其中19例（76．0％，19／25）患者的副肾动脉走向肾上极。1例患者的左侧精索静脉与肾静脉直径相当，二者与腰静脉同时汇人下腔静脉。结论肾动脉的变异较肾静脉常见。副肾动脉出现率较高，多走向肾上极。在腹腔镜肾脏手术中，应对肾血管变异引起高度重视。

Objective To study the variation of renal vessels with retroperitoneal laparoscopy so as to increase the safety of retroperitoneal laparoscopic surgeries. Methods A total of 525 patients underwent retroperitoneal laparoscopic nephrectomy or partial nephrectomy at our hospital between January 2004 and June 2008. There were 316 males and 209 females with a mean age of （58 ± 13） years old. The procedures were as follows： （1） patients lay on one side with their waist up and the retroperitoneal cavity was established with our institutional method; （2） gerota＇s fascia was separated widely along the ventral surface of major psoas muscle ; （3） the tissues around renal arteries and veins were isolated by ultrasonic scalpel. Careful observation was performed to explore if there were duplicated or accessory renal vessels; （4） renal vessels were cut by Endo-GIA/Hem-o-lok or blocked by bulldog clamps; （5） whole or partial kidney was finally resected （remaining procedures omitted）. Results Among all patients, 58 patients （ 11.0% , 58/ 525） had a variation of renal vessels. There were double renal arteries on one side （n = 18） , double renal veins （ n = 10 ）, 3 renal veins （ n = 1 ） and double arteries and veins on one side （ n = 3 ）. Twenty-five patients （4. 8%, 25/525） had one accessory renal artery on one side while 19 （76.0% , 19/25） accessory renal arteries went toward the upper kidney pole. The diameter of one patient＇s left spermatic vein was similar with that of renal vein and they were joined by lumber vein. Conclusion The variation of renal artery is more common than that of renal vein. The accessory renal arteries are common and usually go toward the upper kidney pole. The variation of renal vessels should be considered before and during a laparoscopic procedure.