Tamura N, Ku K, Shichiri Y, Nishimura M, Shioyama R, Kondoh M, Imoto M, Nishimura K, Komeda M
Department of Cardiovascular Surgery, Otowa Hospital, Kyoto, Japan.
Kyobu Geka. 2001 Mar;54(3):188-90.
A 58-year-old woman experienced a sudden onset of severe chest and back pain and thus visited our center in October 1999. Contrast-enhanced computed tomography (CT) revealed a Stanford type A acute aortic dissection. The CT also demonstrated a 50 mm ascending aorta and dissection from the ascending aorta via the abdominal aorta to the level of the left renal artery. The perioperative transesophageal echocardiogram showed an intimal tear in the ascending aorta without valvular abnormality. Therefore, we performed graft replacement of the ascending aorta. On the first postoperative day, she developed oliguria and showed a sudden rise in serum creatinine (Cr) and blood urea nitrogen (BUN) levels, necessitating hemodialysis. She required daily hemodialysis or hemofiltration for twenty days. Thereafter, renal function recovered and dialysis was no longer performed. However, on postoperative day 26, the patient complained of sudden lumber pain. Unheralded oliguria was associated with worsening renal function. A CT scan at this point revealed infarction of the left kidney. During surgery, the left kidney was excised for heterotopic autotransplantation. Extensive thrombosis within a true lumen of the left renal artery was revealed. Following removal of the thrombus and perfusion with heparinized cold saline, renal autotransplantation to a heterotopic site in the pelvis were performed. Although the patient required hemodialysis for five days, renal function recovered gradually. She was discharged five months later. In our experience, it appears that heterotopic renal autotransplantation by which normal arterial perfusion distal to the dissection is reestablished is a good therapeutic option for reperfusion of the ischemic kidney compromised by a progressive dissection of the thoracoabdominal aorta.
一名58岁女性于1999年10月突然出现严重的胸痛和背痛，遂就诊于我院。增强计算机断层扫描（CT）显示为斯坦福A型急性主动脉夹层。CT还显示升主动脉直径50mm，且夹层从升主动脉经腹主动脉延伸至左肾动脉水平。围手术期经食管超声心动图显示升主动脉内膜撕裂，无瓣膜异常。因此，我们对升主动脉进行了人工血管置换术。术后第一天，患者出现少尿，血清肌酐（Cr）和血尿素氮（BUN）水平突然升高，需要进行血液透析。她连续二十天每天都需要进行血液透析或血液滤过。此后，肾功能恢复，不再进行透析。然而，术后第26天，患者主诉突然出现腰痛。毫无预兆的少尿与肾功能恶化相关。此时的CT扫描显示左肾梗死。手术中，将左肾切除用于异位自体移植。术中发现左肾动脉真腔内广泛血栓形成。清除血栓并用肝素化冷盐水灌注后，将肾脏自体移植到骨盆的异位部位。尽管患者术后需要进行五天的血液透析，但肾功能逐渐恢复。五个月后患者出院。根据我们的经验，通过异位肾自体移植重建夹层远端正常动脉灌注，似乎是治疗因胸腹主动脉进行性夹层而导致的缺血性肾再灌注的一种良好治疗选择。
