原位开放手术修复复杂性肾动脉瘤的效果与经验  

In Situ open surgical repair for complex renal artery aneurysm:Outcomes and technical considerations

作　　者：段鹏超 陈麓羽 袁丁[1] 赵纪春[1] DUAN Pengchao;CHEN Luyu;YUAN Ding;ZHAO Jichun(Division of Vascular Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China School of Medicine,Sichuan University,Chengdu 610041,P.R.China;Ward 1 of General Surgery,West China Tianfu Hospital,Sichuan University,Chengdu 610213,P.R.China)

机构地区：[1]四川大学华西医院普外科,血管外科病房,成都610041 [2]四川大学华西临床医学院,成都610041 [3]四川大学华西天府医院,普外一病房,成都610213

出　　处：《中国普外基础与临床杂志》2025年第4期441-447,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结1例通过原位开放手术修复的复杂性单侧肾动脉瘤的诊治过程及效果。方法回顾性分析四川大学华西医院血管外科于2021年12月收治的1例行原位开放手术治疗的复杂性肾动脉瘤患者的临床资料。结果该例为41岁女性患者,体检发现左肾动脉瘤。CT肾动脉三维成像显示动脉瘤体积较大、解剖结构复杂;瘤体位于肾门处,不仅有多支流出道,且与肾实质、输尿管位置紧密。采用原位肾动脉瘤切除联合肾动脉分支重建及大隐静脉搭桥术治疗该肾动脉瘤。总手术时间为5 h,患者术中尿量为250 mL,术中出血量约400 mL;术中共输注红细胞悬液4 U、自体回收血200 mL以及血浆400 mL。术后36个月随访结果显示,重建后肾动脉分支及桥血管血流满意,肾功能未受影响。结论本例结果提示,累及多分支的复杂性肾动脉瘤,瘤体原位切除后行血管重建及主肾动脉搭桥术修复血流是安全可行的,长期预后较好,但是需要强调术前对于肾动脉瘤解剖应进行详细评估以确定原位重建方式,本研究结果也需要积累病例来进一步验证。Objective To summarize the diagnosis,surgical management,and outcomes of one case of complex unilateral renal artery aneurysm repaired by in situ open surgery.Method The clinical data of a patient with complex renal artery aneurysm admitted to the Department of General Surgery,West China Hospital of Sichuan University in December 2021 who underwent in situ open surgery were retrospectively analyzed.Results The patient was a middleaged(41 years old)female with a left renal artery aneurysm detected on physical examination.The renal artery threedimensional CT imaging showed that the aneurysm was large in size and complex in anatomical structure;the aneurysm was located at the renal hilum,demonstrating multiple outflow tracts and close proximity to renal parenchyma and the ureter.Surgical management included in situ aneurysm resection combined with renal artery branch reconstruction and great saphenous vein bypass grafting.The operation duration was 5 h and the intraoperative urine output was 250 mL,and the intraoperative blood loss was about 400 mL.Four units of erythrocyte suspension,200 mL of autologous recycled blood,and 400 mL of plasma were transfused during the operation.The results of the 36-month postoperative follow-up showed that the reconstructed renal arterial branches and the bridging vessel had satisfactory blood flow,and renal function was unaffected.Conclusions The results of this case suggest that in complex renal artery aneurysms involving multiple branches,in situ resection of the aneurysm followed by revascularization and main renal artery bypass grafting to restore flow is safe and feasible,and the long-term prognosis is good.However,it should be emphasized that the anatomy of renal artery aneurysms should be evaluated in detail preoperatively to determine the method of in situ revascularization.The results of the study also need to be further validated by larger samples and multicenter studies.

关 键 词：肾动脉瘤 开放手术 动脉重建 效果 

分 类 号：R699.2[医药卫生—泌尿科学]