14例亲属活体供肾动脉变异的血管重建

目的 探讨亲属活体供肾动脉变异的血管重建方法.方法 在104例亲属活体供肾移植中,有14例供肾动脉变异.供肾动脉变异的分类和血管重建方法分别为:(1)单支动脉较早分支型2例,取肾时分支受损,分别用受者髂内动脉及其分支、腹壁下动脉离体重建受损动脉.(2)双支动脉型10例,4例用受者髂内动脉及其分支离体重建血管,3例用受者腹壁下动脉与较细分支于体内吻合,1例较短肾动脉与较长肾动脉端侧吻合,1例较细副.肾动脉与主肾动脉端侧吻合,1例双支分别与髂外动脉端侧吻合.(3)3支动脉型2例,1例用受者髂内动脉及分支离体重建血管,1例结扎细小分支后,将较细的副肾动脉与主肾动脉端侧吻合.14例血管重建后,分别将供肾动脉较粗支和/或髂内动脉主干端与受者髂外动脉端侧吻合.结果 术后各支动脉血流通畅,移植.肾血液供应丰富、均匀.12例肾功能早期恢复正常,其中1例术后第14天发生急性排斥反应.1例术后即发生急性排斥反应;1例血肌酐下降缓慢.随访至2008年7月,除1例动脉粥样硬化较重的受者(三支动脉)下极动脉栓塞,血肌酐升高并稳定在170μmol/L外,其余患者动脉血流通畅,血液供应丰富、均匀.结论 供肾动脉变异时,利用所得供肾动脉的自身条件重建血管,或用受者髂内动脉及分支或腹壁下动脉重建血管,可获得较好的移植肾功能.受者动脉粥样硬化较重,同时有较细肾动脉支做重建吻合时,应注意该支动脉发生栓塞的可能.

Vascular reconstruction of variant donor renal arteries in 14 living-related kidney transplant cases

Objective To investigate methods of vascular reconstruction for variant donor renal artery(RA)in living-related kidney transplantation(KTX).Methods Among 104 living-related kidney transplants performed in our center,there were 14 living-donor renal arterial variations,including 2 cases of early division(ED)of single renal artery(SRA),10 cases of double(DRA)and 2 cases of triple renal artery(TRA).Branch arteries of ED were injured when kidneys were harvested,and vascular reconstruction was performed with recipients' internal iliac artery(InlA)and its branches,or inferior epigastric artery(IEA).In 10 cases of DRA,vascular reconstruction was performed with InIA and its branches in 4 patients or with IEA in 3 patients.Short RA was end-to-side anastomosed to longer RA in one DRA patient.accessory RA was end-to-side anastomosed to main RA in one DRA patient,and 2 RAs were end-to-side anastomosed to externaliliac artery(EIA) in another one.Vascular reconstruction was performed with InIA and its branches in one TRA patient,and accessory RA was end-to-side anastomosed to main RA after ligating the minor branches in another TRA patient.In all the 14 patients,RA and InIA trunk were respectively or jointly anastomosed to EIA in an end-to-side manner.Results After transplantation,sufficient and uniform blood supply to grafts was observed without RA obstruction.Graft function fluently recovered in 12 patients,in one of whom acute rejection(AR)occurred at day 14.One patient showed slow decrease of serum creatinine(SCr),and AR occurred in another one right after KTx The TRA patient with severe artherosclerosis developed polar renal artery embolism.whose SCr increased and maintained at 170 μmol/L without medical intervention.During the follow-up to July 2008,the remaining patients showed normal blood flow and sufficient blood supply.Conclusions Vascular reconstruction of variant donor renal artery can be performed with its own vascular condition after kidney harvest,or recipient's internal iliac artery and its branches or inferior epigastric artery,which is an effective way to obtain good graft function.For patients with artherosclerosis,artery embolism should be concerned when tiny renal artery is anastomosed.