CAJ | 학술논문

目的探讨亲属活体供肾移植中利用受者腹壁下动脉(IEA)重建供肾副肾动脉(ARA)的临床效果.方法存在ARA的亲属活体供肾16个,其中单支型15个,多支型1个.5个供肾的ARA位于上极,1个位于中部,9个位于下极,1个供肾的中部和下极各有一支ARA,其开口直径为1.5～3.5 mm.供肾热缺血时间为1～6.5 min,冷缺血时间为15 90 min.除多支型1例的中部ARA与肾动脉主干行端侧吻合外,其余16支ARA均与受者的IEA重建.ARA位于上极的5个供肾中,3个由于ARA过短,而供肾因为输尿管原因又不适于颠倒以与IEA重建,遂切取一段长3～6cm的供者生殖腺静脉,对ARA进行延长,再将ARA与IEA进行重建.术后采用多普勒超声检查移植肾血流,监测血清肌酐(Cr).结果所有IEA与ARA的吻合均一次完成,吻合时间为(4.9±1.4)min,开放IEA后,见IEA和ARA均搏动良好,吻合口通畅.仅2例术中发生吻合口漏血,经热盐水纱布轻压局部2～3 min后出血停止.术后第3天,多普勒超声检查显示,16例移植肾的ARA供血区域血流丰富,局部动脉阻力指数正常(<0.7).所有肾脏均在恢复血液供应后10 min内开始泌尿,术后血清Cr均迅速下降至正常.16例未发现下肢血管并发症的发生.术后随访6个月,未见局部动脉栓塞,也无输尿管坏死发生.结论对于存在ARA的供肾,可利用受者的IEA进行重建,此术式适用于ARA与肾动脉主干或其他动脉吻合存在困难者.
목적 탐토친속활체공신이식중이용수자복벽하동맥(IEA)중건공신부신동맥(ARA)적림상효과.방법 존재ARA적친속활체공신16개,기중단지형15개,다지형1개.5개공신적ARA위우상겁,1개위우중부,9개위우하겁,1개공신적중부화하겁각유일지ARA,기개구직경위1.5～3.5 mm.공신열결혈시간위1～6.5 min,랭결혈시간위15 90 min.제다지형1례적중부ARA여신동맥주간행단측문합외,기여16지ARA균여수자적IEA중건.ARA위우상겁적5개공신중,3개유우ARA과단,이공신인위수뇨관원인우불괄우전도이여IEA중건,수절취일단장3～6cm적공자생식선정맥,대ARA진행연장,재장ARA여IEA진행중건.술후채용다보륵초성검사이식신혈류,감측혈청기항(Cr).결과 소유IEA여ARA적문합균일차완성,문합시간위(4.9±1.4)min,개방IEA후,견IEA화ARA균박동량호,문합구통창.부2례술중발생문합구루혈,경열염수사포경압국부2～3 min후출혈정지.술후제3천,다보륵초성검사현시,16례이식신적ARA공혈구역혈류봉부,국부동맥조력지수정상(<0.7).소유신장균재회복혈액공응후10 min내개시비뇨,술후혈청Cr균신속하강지정상.16례미발현하지혈관병발증적발생.술후수방6개월,미견국부동맥전새,야무수뇨관배사발생.결론 대우존재ARA적공신,가이용수자적IEA진행중건,차술식괄용우ARA여신동맥주간혹기타동맥문합존재곤난자.
Objective To approach the significance of reconstructing allograft accessory renal artery (ARA) with recipient inferior epigastric artery (IEA) in living-related kidney transplantation. Methods In 16 cases of ARA, ARA located at upper pole in 5 cases, middle part in 2, and lower pole in 9, respectively. Kidney allografts had 1～6.5 min warm ischemia time and 15～90 min cold ischemia time. Reconstruction of ARA was made by anastomosing ARA to recipient lEA, except one middle ARA by anastomosing to recipient main renal artery. Three cases were reconstructed by bridging ARA and IEA with gonad vein. All cases were examined by Doppler ultrasound and serum creatinine test post-transplantation. Results ARA-IEA anastomosis was completed in all cases. Blood circulation of the allografts supplied by ARA was restored immediately after releasing the clamps to IEA. Normal blood circulation was showed in 16 grafts by Doppler ultrasound on the 3rd day postoperatively. The levels of serum creatinine and creatinine clearance in the recipients with ARA reconstruction were comparable to those of the recipients with normal allografts during the first 3 day postoperatively. All cases had no complications of lower extremity blood vessels. No artery occlusion and ureteral necrosis were found in the recipients within a 6-month follow-up period. Conclusion IEA is a choice for reconstructing allograft ARA to which there is difficulty in reconstructing with other arteries.