马蹄肾供肾肾移植2例报告

Successfully implemented horseshoe kidney for kidney transplantation： a case report and the literature review

目的探讨马蹄肾作为供肾的临床肾移植效果及手术经验总结。方法回顾分析2015年8月1例心脏死亡供者捐献的马蹄肾作为供肾，成功为2例尿毒症患者施行肾移植术的临床资料。供者因自发性脑出血发生心脏死亡，符合中国二类标准进行器官捐献。捐献前供者尿量及血肌酐正常，未发现肾脏先天畸形以及相关病史。受者1为男性，年龄49岁，慢性肾炎，肾功能衰竭，透析治疗9个月余；受者2为男性，年龄42岁，IgA肾病，慢性肾炎肾功能衰竭，透析治疗1个月余。供肾获取时，采用低位髂血管插管灌注；供肾修整时仔细分离各动静脉分支，最后结扎峡部小分支动脉，分离峡部，并U形缝合峡部断端。左肾动脉双支，分别带主动脉袖片与受者1的髂外动脉行2个端侧吻合；单支肾静脉与受者髂外静脉行端侧吻合。右肾动脉3支，其中2支与受者2的髂外动脉端侧吻合，肾下极1支与远心端髂外动脉行端端吻合；静脉双支带下腔静脉行延长后，与受者2的髂外静脉行端侧吻合。双侧输尿管肾盂段均有轻度扩张，余无异常，均与受者膀胱行常规隧道包埋法吻合。2例受者术后均采用他克莫司＋吗替麦考酚酯＋泼尼松预防排斥反应。结果肾移植手术耗时3h左右。术后受者尿量均在2000ml／d以上，血肌酐逐渐下降至正常，恢复满意，均于2周左右出院。结论在供肾功能良好，充分评估及仔细操作的情况下，马蹄肾可以作为安全的供肾。

Objective To explore the outcomes of horseshoe kidney as the donor for clinical kidney transplantation and summarize clinical experience with related literatures. Methods We retrospectively analyzed the clinical documents of two uremia patients successfully transplanted with horseshoe kidney free of complications donated by a cardiac death patient in August, 2015. The donor was a 43-year-old man and had normal renal function. Due to cerebral hemorrhage, the donor became cardiac death and was performed organ donation. Recipient I was 49-year-old with diabetic nephropathy and dialysed about 9 months, and recipient 2 was 42-year-old with IgA nephropathy and dialysed about 1 month. We cannulated from the iliac artery to perfuse the organ. And we found that there were two renal arteries and one renal vein on the left side, and three renal arteries and two renal vein with cava! valves on the right side, and the isthmus was perfused by two accessory arteries when trimming the kidney., All the renal arteries were anastomosed to the external iliac artery, and the renal veins were anastomosed to the external iliac vein. The edge of the isthmus was sutured. Ureters were routinely performed by tunnel embedding sutured. We used triple immunosuppressive scheme with tacrolimus, mycophenolatemofetil and methylprednisolone to prevent rejection. Results The operation time was about three h. Two recipients recovered well postoperatively with more than 2000mL urineper day and gradual decline of serum creatinine. The two recipients were discharged in about 2 weeks. Conclusion Horseshoe kidney may be used for transplantation in cases whose renal function was normal and under detailed preoperative evaluation.