小儿重复肾血管变异的临床应用解剖

The applied anatomy of vascular variability of duplex kidney in children

目的 研究重复肾血管解剖,为手术切除病变肾段提供科学依据。 方法 回顾性分析2012年2月至2018年4月我院收治的84例上肾重复肾患儿的临床资料。男20例,女64例;年龄0.2~11.8岁,平均2.5岁。患儿因泌尿系感染、漏尿、腹部包块、体检超声检查发现重复肾异常等入院。84例中单侧重复肾75例(89.3%),双侧9例(10.7%)。根据术前CT血管造影及术中所见重复肾形态、大小、位置、重复肾段解剖关系重点,结合上肾段动脉血管的分支和走行,描述重复肾上肾段动脉血供情况。分析重复肾上肾段血管数量及走行与性别的关系。 结果 本组84例共93侧中,68侧(73.1%)上肾段为1支动脉供应,25侧(26.9%)为≥2支动脉供应。基于上肾段供应动脉走行及开口情况,分3类:①提前分支类,共71侧(76.3%),为肾动脉在肾门贴近肾实质处分出2支或多支血管,分别供应上下肾段;②副肾动脉类,共18侧(19.4%),为腹主动脉或其分支发出动脉直接汇入上肾段;③其他类,共4侧(4.3%),包括提前分支加副肾动脉的混合类和肾上腺动脉分支供应重复肾上肾段的情况。在血管变异中,不同性别重复肾上肾段供应血管数量(P=0.19)和血管走行(P=0.83)情况的差异均无统计学意义。 结论 重复肾上肾段供应动脉数量方面以单一肾动脉分支为主;走行方面以提前分支类为主;供应动脉数量和走行无性别差异。了解重复肾上肾段血管变异情况,可为术中避免出血及误伤正常血管提供依据。

Objective To study the vascular anatomy of duplex kidney and to provide a scientific basis for surgical resection of the renal segment.Methods From February 2012 to April 2018, the clinical data of 84 children with renal duplex kidney disease admitted to our hospital, were reviewed and analyzed. Among them, 75 cases (89.3%) were unilateral and 9 cases (10.7%) were bilateral. According to the preoperative CT+ CTA and the duplicated renal morphology, size, location, and anatomical relationship of the kidney segment, combined with the branches and passage of the renal artery which supplies the upper moiety, it described the blood supply of the upper renal moiety. At the same time, it analyzed various types of embryological related factors and gender differences and summarized the tips for laparoscopic surgery.Results Of the 93 duplex kidneys, 69 (74.2%) were supplied with 1 artery, and 25 (26.9%) were supplied with 2 or more arteries. Based on the shape and orifice of artery, they were divided into 3 types. The most common type was that the renal artery separated into two or more arteries near the renal parenchyma. The upper and lower renal poles were respectively supplied, which could be summarized as early branching, a total of 71 sides (76.3 %). The second type was the arteries from abdominal aorta or its branches, directly flowing into the upper renal pole, which was classified into the sub-renal artery, a total of 18 sides (19.4%). The others (4 sides, 3.3%) were less common, and most of them were a combination of the above-mentioned two types, and one of them whose upper pole was supplied by branches of adrenal artery. Based on the classification of vascular variability, no significant difference was found between males and fenmals, or left and right sides.Conclusions The upper renal moiety are mainly supplied by one branch of renal artery, and the most common type of this artery is prehilar branch, without gender difference. The determination of vascular variability before surgery can avoid bleeding during surgery and avoid accidental injury of normal blood vessels.