一种新的大鼠部分门静脉动脉化模型

目的建立操作简便、稳定可靠、重复性好的大鼠部分门静脉动脉化模型(PPVA)。方法采用""型同种异体血管材料(上、下端套袖套,侧端旷置),以套入式缝合及袖套法建立大鼠模型。切除左肾,将左肾动脉与门静脉残端、肠系膜上静脉借同种异体血管材料连接。结果 PPVA组30只大鼠中3只术后死亡,模型成功率90.0%(27/30)。术后30d,PPAV组病理检查未见异常,门静脉通畅率为96.3%(26/27),与对照组谷草转氨酶、谷丙转氨酶、血清白蛋白、胆碱酯酶、体重水平比较差异无统计学意义(P0.05)。结论采用同种异体血管借助套入式缝合及袖套法建立大鼠部分门静脉动脉化模型操作简单、重复性好、成功率高。     

用袖套式血管吻合法建立大鼠肝、肠联合移植模型

目的 建立肝、肠联合移植手术模型。方法 用Ｗｉｓｔａｒ大鼠行同种异体肝、肠联合移植。先行肝移植,再行小肠移植。肝脏为原位移植,供肠异位移植于左肾处（切除左肾）。门静脉、肝下下腔静脉和肠系膜上静脉采用袖套式吻合法分别与受者的门静脉、肝下下腔静脉和左肾静脉吻合,回肠末端在左下腹造瘘。结果 手术成功率为６２．５％,动物平均存活时间１１．２ｄ。组织学检查发现移植肝和小肠发生排斥反应。结论 用袖套式血管吻合     

袖套式血管吻合法建立肝肠联合移植的实验研究

目的 建立一种新肝肠联合移植手术模型,探讨移植肝脏对移植小肠的保护作用.方法Wistar大鼠同种异体肝肠联合移植,供体手术时门静脉和肠系模上动脉进行双重冷灌注,用冷新霉素液冲洗小肠肠腔并清洁.受体手术的先进行肝脏移植,再进行小肠移植,门静脉、肝下下腔静脉袖套式吻合,肠系膜上动脉在显微镜下与左肾动脉油套式吻合,供体肠系膜上静脉袖套式与受体左肾静脉吻合,回肠下端在左下腹部造□,完成肝肠联合移植.结果 手术成功率为62.5%(15/24),手术平均存活为11.2天.手术后组织学发现:移植肝脏和小肠发生排斥反应.结论(1)袖套式血管吻合技术在大鼠身上建立的肝肠联合移植模型是可行的.(2)肝肠联合移植后移植的肝脏不能起到保护移植小肠的作用.     

大鼠改良式原位肝移植手术技巧探讨

目的 探讨建立稳定大鼠原位肝移植模型的手术操作技巧. 方法成年雄性SD大鼠200只,体重200～250 g;成年雄性Wistar大鼠60只,体重230～280 g,供体体重小于受体约30 g.其中SD大鼠为供、受体的同基因肝移植70只(SD-SD组),SD、Wistar分别为供、受体的同种异体肝移植60只(SD.Wistar组).采用改良二袖套法行大鼠原位肝移植,充分暴露第一肝门,不翻动肝脏先行门静脉灌注;在体一步法离断肝上下腔静脉,不带膈肌环;吻合肝上下腔静脉采用单线连续缝合;双线牵引法安装门静脉袖套.术后充分补液维持大鼠血液动力学稳定. 结果 供体手术时间(38.2 ±2.5)min,受体手术时间(45.6±3.5)min,无肝期(15.1±2.2)min,手术成功率93%,1周存活率92%,与传统二袖套法比较差异有统计学意义(P＜0.05).SD-SD组手术成功64只,受体存活时间2～9个月,平均145 d;术后约3 d 肝功能恢复正常,肝组织病理无明显变化.SD-Wistar组手术成功57只,受体存活时间8～20 d,平均10.5 d;大鼠于术后3～5 d出现急性排斥反应,未经处理后均死亡. 结论 改良式肝移植操作简便,成功率高,可为大鼠原位肝移植实验提供稳定可靠的动物模型.     

袖套法制作大鼠胰腺移植模型

目的:建立一种改进的大鼠胰腺移植模型.方法:共完成80例大鼠胰腺移植,术中不阻断受体下腔静脉,用袖套法完成供体门静脉与受体左肾静脉断端的吻合,动脉用缝合法吻合.结果:受体平均手术时间50 min,静脉袖套吻合时间3 min,腹主动脉阻断时间10 min,冷缺血时间50 min.手术成功率达90%.移植术后胰腺功能恢复正常,组织病理学改变轻微.结论:袖套法制作大鼠胰腺移植模型操作简单,成功率高,结果稳定.     

应用显微外科技术建立大鼠一期肝肾联合移植模型

目的 探讨应用显微外科技术建立稳定、可靠的大鼠一期肝、肾联合移植模型的手术技巧。方法 SD大鼠78只，39只作供体，39只作受体。供体经腹主动脉以4℃乳酸钠林格注射液同时对供肝和供肾进行原位灌洗。原位肝移植时除肝上下腔静脉缝合外，其余血管重建均采用袖套式吻合；肾移植采用将供肾的血管与受体的同名的血管作端端吻合的大鼠原位左肾移植。结果 共施行大鼠原位肝、肾联合移植手术39例，手术成功率为92．3％，术后最长存活的时间超过12个月。结论 娴熟的显微外科技术、细致的手术操作是建立肝、肾联合移植模型的先决条件。已建立的模型稳定性强、重复性好，适合于多器官移植中移植免疫的基础研究。     

cuff管套入法建立大鼠同种异体睾丸移植模型

目的:探索应用cuff管套入法建立大鼠同种异体睾丸移植模型的新方法。方法:60只健康雄性近交系W istar大鼠分别作为供、受体,显微镜下(×10),连同左侧供睾的动、静脉一起截取与其相连的腹主动脉段和左髂总静脉段,以丝线结扎左髂总静脉段的远断端,其余3断端分别套上cuff管后袖套状翻转并以丝线环扎之,然后分别将外套cuff管的动、静脉嵌入切开的受鼠的腹主动脉内和左髂总静脉内后再环扎,端端吻合受、供体输精管,摘除受鼠双侧睾丸。结果:30只大鼠正式手术,27只长期存活直至处死,2只死于麻痹性肠梗阻伴感染,1只因术中大出血死亡。27只长期存活的受体中,4、4、5例于术后14 d、28 d、56 d探查植睾,血供情况良好,关腹存活至处死;余14只用于其他实验。受体左下肢术后无明显水肿、淤血和坏死。结论:应用cuff管技术建立的大鼠睾丸移植模型具有操作简便、成功率高、效果可靠等优点,可作为睾丸移植的研究模型。     

应用新技术建立大鼠肾移植模型

针对目前大鼠肾移植模型中静脉吻合及原肾切除方法存在的不足 ,我们设计了带临时内支架的供、受体肾静脉吻合以及受体原肾肾血管体外延迟结扎两项新技术 ,用其建立了更为简便、可靠的大鼠肾移植模型。一、材料与方法1.实验动物及麻醉供、受体均采用近交系雄性Ｌｅｗｉｓ大鼠 ,共 46只 ,随机分为数量相等的供、受体对。以 10 ｇ/Ｌ戊巴比妥钠腹腔注射麻醉。2 .供体手术 :取左肾作为供肾。开腹后 ,于髂血管分叉上方钳夹腹主动脉及腔静脉 ,结扎远端后 ,紧贴血管钳下方切断血管 ,将腹主动脉及腔静脉近心断端提起 ,将其两侧分支逐一结扎至左肾静…     

大鼠胰十二指肠移植动物模型的制作

目的　建立大鼠腔静脉内分泌引流、肠道外分泌引流的动物模型。方法　雄性SD大鼠为供受者,供体鼠门静脉与受体鼠左肾静脉行袖套吻合,形成腔静脉内分泌引流;供者腹主动脉与受者腹主动脉行端侧吻合;供者十二指肠与受者近端空肠行侧侧吻合。结果　5 0只药物诱导的糖尿病大鼠移植术后超过2 4h者46只,手术时间为(93±7)min。移植前大鼠血糖为(2 8.3±1.7)mmol/L ,移植后43只大鼠血糖降至正常水平。结论　该模型方法简单易行,可作为胰腺移植的理想模型     

大鼠腹腔同种异体异位心脏移植模型的建立与改进

目的建立并改进大鼠腹腔同种异体异位心脏移植模型,探讨其可行性及安全性。方法对100只Wistar大鼠腹腔同种异体异位心脏移植模型的麻醉方法、供心灌注切取、受体血管准备、吻合方法等进行了改良,术后统计手术时间及手术成功率。结果供体准备、供心摘取时间共（13±3）min,受体血管准备时间（8±2）min,受体腹主动脉吻合时间（10±2）min,受体下腔静脉吻合时间（7±3）min,供心冷缺血时间（30±6）min。手术成功大鼠恢复血供到开始心室纤颤时间（5±2）s,心室纤颤期为（10±3）s。100只中,成功94只,成功率为94%,死亡6只,包括术中麻醉意外死亡3只,术中误伤心耳出血死亡2只,肺血管结扎处出血死亡1只。结论大鼠腹腔同种异体异位心脏移植模型的操作方法经过改进后,降低了手术难度,手术成功率较高。     

Anomalies of the inferior vena cava

The inferior vena cava is formed by a complex process of embryogenesis during the sixth to tenth week of gestation. Improper completion of the process may result in four anatomic anomalies: duplication of the inferior vena cava, transposition or left-sided inferior vena cava, retroaortic left renal vein, and circumaortic left renal vein. The first two anomalies can be diagnosed by sonography and all four anomalies can be seen on CT scan of the abdomen. Duplication and transposition of the inferior vena cava should be further delineated by preoperative phlebography. Preoperative diagnosis of the anomalies should reduce the complication rate of abdominal aortic operations.     

Endovascular management of recurrent stenosis following left renal vein transposition for the treatment of Nutcracker syndrome

Nutcracker syndrome is an entity resulting from left renal vein compression by the superior mesenteric artery and the aorta, leading to symptoms of left flank pain and hematuria. Conventional treatment has been surgical, commonly through transposition of the left renal vein to a more caudal location on the inferior vena cava. Additionally, endovascular approaches, primarily via renal vein stenting, have been described for treatment of this syndrome. We report the case of a patient with Nutcracker syndrome who underwent successful left renal vein transposition but then developed recurrent symptoms 10 months postoperatively and was successfully treated with angioplasty and stenting.     

Aortic and inferior vena cava resection for renal cell carcinoma invading an aberrant renal vein

Renal cell carcinoma which invades the renal veins is a frequent complicating factor in radical nephrectomy. In a 53-year-old patient with a left renal cell carcinoma, tumor thrombus was present in an aberrant, retroaortic left renal vein, and "en bloc" resection of the overlying aneurysmal aorta with a cuff of inferior vena cava was required. The aorta was reconstructed with a dacron bifurcation graft to the iliac arteries, and the vena cava closed primarily. The patient made an uneventful postoperative recovery. The requirement for extensive aortic and vena cava resection need not compromise attempts to cure locally advanced renal cell carcinoma.     

Laparoscopic nephrectomy in patients with renal vein and/or inferior vena cava anomalies: Video presentation

Abstract:   Laparoscopic nephrectomy is a standard surgery for the treatment of many types of renal tumor, renal pelvic tumor, and benign disease. Renal vein and inferior vena cava anomalies are not uncommon, having been detected at an incidence of 2–17%. With the increasing number of patients undergoing laparoscopic nephrectomy, surgeons have more opportunities to encounter major anomalies of the renal vein and inferior vena cava. This video presents images of the management of the renal pedicle in laparoscopic nephrectomy in cases where there were anomalies of the renal vein and inferior vena cava.
Patient 1 had left renal tumor with the left inferior vena cava, patient 2 had left ureteral tumor with double inferior vena cava, patient 3 had left renal tumor with double inferior vena cava and a circumaortic renal vein, patient 4 had left renal tumor with a retro-aortic renal vein, and patient 5 had left renal tumor with a circumaortic renal vein. Multiple renal arteries were present in patients 3, 4, and 5.
In laparoscopic nephrectomy complicated by anomalies of the renal vein and inferior vena cava, (i) surgical staff should be alert for the potential presence of aberrant veins and multiple renal arteries that may not be visualized in preoperative imaging. (ii) An anterior transperitoneal approach is well-suited in the understanding of positional relationships of vessels and anatomical landmarks in cases of vascular anomalies. (iii) With recent advances in diagnostic imaging modalities, such as multislice computed tomography (CT) and 3-D CT, it has become easier to identify the major arterial and venous anomalies. However, intraoperative observation and assessment remain important and mandatory in the management of smaller anomalous vessels accompanied by major anomalies.     

Infrarenal venous anomalies and aortic surgery: avoiding vascular injury

Anomalies of the left renal vein (retroaortic left renal vein and left renal vein collar) and the inferior vena cava (left-sided inferior vena cava and caval duplication) occur relatively infrequently but pose potential hazards to the surgeon during aortic repair. We report the cases of three patients in which one or a combination of these anomalies of the renal vein and inferior vena cava was present. The embryologic origins of each of the anomalies are discussed, and suggestions, both surgical and nonsurgical, are proposed that might aid the surgeon in avoiding injury and subsequent bleeding from these anomalous structures during surgical operations on the abdominal aorta.     

腹腔镜下微创手术治疗肾癌合并高位肝后下腔静脉癌栓

目的探讨腹腔镜下微创手术治疗肾癌合并高位肝后下腔静脉癌栓的临床经验和文献分析。 方法女性患者,61岁,临床诊断：右肾癌合并高位肝后下腔静脉癌栓。术前全面评估手术风险,组织多学科会诊为患者制定详尽的围手术期治疗与护理方案,拟行腹腔镜下右侧肾癌根治性切除+高位肝后下腔静脉癌栓取出+腹膜后淋巴结清扫术。术后医护密切配合严密观察患者病情变化,进行围手术期观察处理与护理。 结果手术顺利完成,手术时间390 min,无中转开放手术。术中完全游离右侧和左侧肾静脉、肝后下腔静脉直达第二肝门水平远端,近右肾静脉处下腔静脉内侧壁剪开静脉壁,癌栓下部小灶性侵犯静脉壁,切除部分腔静脉壁完整取出癌栓,恢复左侧肾静脉、腔静脉血流回流无障碍。术后病理提示符合透明细胞癌,癌组织侵犯肾窦脂肪,腹膜后淋巴结（-）。术后随访6个月未见肿瘤复发。 结论腹腔镜下微创手术治疗肾癌合并高位肝后下腔静脉癌栓安全可行,多学科协助模式为疑难复杂病例提供了一种新的选择,值得临床进一步推广。     

Hand assisted laparoscopic radical nephrectomy for renal cell carcinoma with inferior vena caval thrombus

PURPOSE: To our knowledge we present the initial clinical report of hand assisted laparoscopic radical nephrectomy for renal cell carcinoma with tumor thrombus extending into the inferior vena cava. MATERIALS AND METHODS: A 76-year-old man was referred to our medical center with a 12.5 x 10 cm. stage T3b right renal tumor extending into the inferior vena cava. The caval thrombus was limited and completely below the level of the hepatic veins. After preoperative renal embolization via the hand assisted transperitoneal approach the right kidney was completely dissected with the renal hilum. Proximal and distal control of the inferior vena cava was obtained with vessel loops and a single lumbar vein was divided between clips. An endoscopic Satinsky vascular clamp was placed on the inferior vena cava just beyond its juncture with the right renal vein, thereby, encompassing the caval thrombus. The inferior vena cava was opened above the Satinsky clamp and a cuff of the inferior vena cava was removed contiguous with the renal vein. The inferior vena cava was repaired with continuous 4-zero vascular polypropylene suture and the Satinsky clamp was then removed. A literature search failed to reveal any similar reports of laparoscopic radical nephrectomy for stage T3b renal cell cancer. RESULTS: Surgery was completed without complication with an estimated 500 cc blood loss. Pathological testing confirmed stage T3b grade 3 renal adenocarcinoma with negative inferior vena caval and soft tissue margins. CONCLUSIONS: The introduction of vascular laparoscopic instrumentation and the hand assisted approach enabled us to extend the indications for laparoscopic radical nephrectomy to patients with minimal inferior venal caval involvement.     

A case of left inferior vena cava discovered by chance at nephrectomy for renal transplantation

A case of left inferior vena cava, in a 35-year-old woman, discovered by chance at nephrectomy for renal transplantation is reported. She was admitted to our hospital as a donor of the kidney to her son. She had no remarkable physical signs on chest or abdomen. All laboratory tests were within normal limits. Intravenous pyelogram showed no major abnormality except for the lower position of left kidney than right one. Abdominal aortogram and selective renal arteriogram revealed no abnormality. Bilateral renal arteries were single. Left nephrectomy for transplantation was performed on April 13, 1983. In this operation the left sided inferior vena cava was discovered by chance. Inferior vena cavography was taken postoperatively. It showed the left sided inferior vena cava, type C. Knowledge of the abnormalities of the left renal vein and inferior vena cava is of surgical importance for the urologist when renal transplantation is being considered.     

Laparoscopic radical nephrectomy with level II vena caval thrombectomy: survival porcine study

PURPOSE: Inferior vena caval tumor thrombus due to renal cell carcinoma generally precludes laparoscopic techniques for radical nephrectomy. We developed the technique of laparoscopic infrahepatic (level II) inferior vena caval thrombectomy in a survival porcine model. MATERIALS AND METHODS: Of the 7 female pigs used in the study 2 were acute and 5 were chronic animals which were allowed to survive for 6 weeks postoperatively. Laparoscopic right radical nephrectomy and inferior vena caval thrombectomy were performed in accordance with established open surgical principles, including vascular control and intracorporeal reconstruction of the vena cava and left renal vein. RESULTS: Complete removal of the simulated caval thrombus was successful in each case without intraoperative or postoperative complications. Average operative time was 160 minutes. Postoperatively inferior venacavography showed a patent vena cava and left renal vein in all animals. CONCLUSIONS: Laparoscopic radical nephrectomy was successful in an animal model simulating renal cell carcinoma with infrahepatic vena caval tumor thrombus. Clinical application of this technique appears possible.