离体肾动脉瘤修补、肾动脉重建和自体肾移植治疗复杂性孤肾肾动脉瘤一例并文献复习

目的探讨离体肾动脉瘤修补、肾动脉重建和自体肾移植技术治疗复杂性孤肾肾动脉瘤的安全性和可行性。方法CT血管造影（CTA）确诊复杂性孤肾肾动脉瘤1例,病变位于肾动脉主干分叉部,累及节段分支动脉,深入肾门内。肾脏暂时性离体后,在低温和肾脏灌注液灌注保护肾脏的前提下,体外进行肾动脉瘤修补和自体大隐静脉肾动脉重建,然后将肾脏异位移植到右侧髂窝。结果手术成功,围手术期无严重并发症发生。术后血肌酐暂时性升高至约200μmol／L,半个月后逐渐恢复正常;术后2周复查CTA示右髂窝移植肾动脉及其分支血流通畅无狭窄,肾静脉回流通畅,输尿管无狭窄。结论该方法治疗复杂性孤肾肾动脉瘤安全可行,并为以后类似的复杂性肾脏疾病的处理提供了可行方法。

Aneurysm repair in vitro and renal revascularization and renal autogenous transplantation for complex renal artery aneurysm in solitary kidney

OBJECTIVE: To discuss the safety and feasibility of aneurysm repair in vitro and renal revascularization and renal autogenous transplantation for complex renal artery aneurysm in solitary kidney. METHODS: A complex hilar renal artery aneurysm involving the bifurcation of renal artery and its branches in a solitary left kidney was diagnosed by computed tomography angiography (CTA). After temporary nephrectomy, aneurysm repair in vitro and renal revascularization were done with the kidney protected by hypothermia and continuous perfusion with preservation solution, and then the kidney was replanted into the right iliac fossa. RESULTS: The operation was done successfully and there were no significant perioperative complications. Although a serum creatinine level temporarily exceeded above 200 micromol/L after the surgery, it recovered gradually within half a month. CTA two weeks later demonstrated patent reconstructed renal arteries and its branches and patent renal vein in the right iliac fossa, and also a patent reconstructed ureter. CONCLUSIONS: This technique is safe and feasible to manage complex renal artery aneurysm in solitary kidney and provide an alternative for similar complex renal diseases.