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目的探讨手助腹腔镜法活体取肾、离体肾动脉瘤切除、肾动脉重建和自体肾移植技术治疗复杂性肾动脉瘤的安全性和可行性。方法2006年10月收治1例42岁复杂性肾动脉瘤男性患者。术前彩超、CT及DSA检查显示左肾动脉瘤3.4cm×4.3cm×4.5cm大小,瘤内有部分血栓形成,位于左肾动脉主干分叉部,累及5支分支动脉,邻近肾门。患者有高血压病史,药物控制不佳。术中采用手助腹腔镜法活体取肾成功后,立即对离体肾脏采用4℃肾脏保存液灌注,低温保护肾脏,体外进行肾动脉瘤切除;切取自体右髂内动脉体外行肾动脉重建,最后将肾脏异位移植至右侧髂窝。结果患者手术成功,围手术期未出现并发症。术后肾功能正常;彩超复查显示右侧髂窝移植肾动脉及其分支血流通畅无狭窄,肾静脉血流通畅,输尿管无狭窄。术后13个月随访,血压恢复正常,肾功能正常。结论离体肾动脉瘤切除和自体肾移植术治疗复杂性肾动脉瘤微创、安全、可行。
Objective To investigate the safety and feasibility of hand-assisted laparoscopic in vivo renal removal, excision of renal artery aneurysm, reconstruction of renal artery and autologous renal transplantation in the treatment of complex renal aneurysm. Methods One male patient with 42-year-old complex renal aneurysm was treated in October 2006. Preoperative ultrasound, CT and DSA showed that the left renal artery aneurysm size of 3.4cm × 4.3cm × 4.5cm, tumor thrombosis, located in the left renal artery bifurcation, involving 5 branch artery, adjacent to the renal portal. Patients have a history of hypertension and poorly controlled drugs. Intraoperative renal laparoscopic hand surgery to take the kidneys successfully, the isolated kidneys immediately 4 ℃ renal preservation solution perfusion, low-temperature protection of the kidneys, renal artery aneurysm resection in vitro; isolated from the right internal iliac artery in vitro renal artery reconstruction, Finally, the kidneys were ectopic transplanted to the right iliac fossa. Results The successful operation of patients, no complications during perioperative period. Postoperative renal function was normal; color Doppler ultrasound showed that the right iliac fossa graft renal artery and its branches flow without stenosis, renal vein blood flow, ureteral stricture. After 13 months follow-up, blood pressure returned to normal, normal renal function. Conclusion Excision of renal artery aneurysm and autologous renal transplantation in the treatment of complex renal aneurysm minimally invasive, safe and feasible.