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目的探讨以受体腹壁下动脉(inferior epigastric artery,IEA)重建移植肾副肾动脉(accessory renal artery,ARA)的临床应用价值。方法26只移植肾中16只为单支型ARA,10只为多支型整形后余留单支型ARA;ARA位于上极12支,中部4支,下极10支;开口直径1.5~3.5mm;用亚甲蓝灌注显示动脉血供范围。行ARA与受者IEA端-端吻合,其中6例上极ARA过短,将移植肾上下位置翻转后吻合。结果26例均吻合成功,再通血流后移植肾ARA供血范围血供恢复良好。术后3d,多普勒超声检查显示:21例局部血流正常;5例局部动脉阻力指数增高,至术后15~21d恢复正常。本组受者术后3d内血清肌酐和肌酐清除率与同期对照组相比差异无统计学意义(P>0.05),随访6个月,无输尿管坏死和局部动脉栓塞发生。结论应用受体IEA可以重建移植肾ARA,血管吻合过程不影响肾功能恢复,适用于ARA与肾动脉主干或其他动脉吻合存在困难的患者。
Objective To investigate the clinical value of reconstructed accessory renal artery (ARA) with inferior epigastric artery (IEA). Methods Twenty-six of 26 renal allografts were single ARA and 10 had multiple ARA. ARA was located on the upper pole 12, middle 4 and lower pole 10, and the diameter of the opening was 1.5-3.5 mm; perfusion with methylene blue shows arterial blood supply range. Line ARA and end of the recipient IEA - end anastomosis, including 6 cases of the pole ARA is too short, the upper and lower kidney graft position after inversion. Results All the 26 cases were anastomosed successfully, and the blood supply of ARA in renal allograft after blood flow was recovered well. Three days after operation, Doppler ultrasonography showed that local blood flow was normal in 21 cases and local arterial resistance index increased in 5 cases, returning to normal after 15-21 days. There was no significant difference in the serum creatinine and creatinine clearance rates between the two groups (P> 0.05) and the 6-month follow-up. No ureteral necrosis and local arterial embolism occurred. CONCLUSION: The application of receptor IEA can reconstruct ARA in renal allografts. The process of vascular anastomosis does not affect the recovery of renal function. It is suitable for patients with ARA who have difficulties in anastomosis of renal artery or other arteries.