Belzer F O, Salvatierra O, Palubinskas A, Stoney R J
Ann Surg. 1975 Oct;182(4):456-63. doi: 10.1097/00000658-197510000-00011.
Ex vivo renal artery reconstruction and autotransplantation is a relatively recent addition to the surgical armamentarium for renal vascular hypertension. Ten consecutive patients were considered for this surgical therapy and form the basis of this communication. The patients were treated by a combination of methods including bilateral ex vivo reconstruction, unilateral in situ and contralateral ex vivo reconstruction, and unilateral ex vivo reconstruction and contralateral nephrectomy. Replacement of the diseased segment of the renal artery in all ex vivo reconstruction consisted of arterial autografts including hypogastric artery, splenic artery, common iliac, and external iliac artery. In the ex vivo reconstruction, the ureter was either left intact or was transected and reconstructed by standard ureterovesicle implantation. After surgery all patients became normotensive without antihypertensive medication. Although this is a relatively small series, the uniform good results in these patients with extensive disease suggest that ex vivo renal artery reconstruction is a safe and effective method of treatment. Thus, it should be more widely applicable, expecially in those patients with renal vascular disease who were previously thought to be inoperable or eligible for nephrectomy only.
体外肾动脉重建及自体肾移植是肾血管性高血压外科治疗手段中较新的一种。连续10例患者接受了这种外科治疗，并构成了本报告的基础。患者采用了多种方法联合治疗，包括双侧体外重建、单侧原位及对侧体外重建、单侧体外重建及对侧肾切除术。在所有体外重建中，肾动脉病变段的置换均采用自体动脉移植，包括腹下动脉、脾动脉、髂总动脉和髂外动脉。在体外重建中，输尿管要么保持完整，要么横断并通过标准的输尿管膀胱植入术进行重建。术后所有患者在未服用抗高血压药物的情况下血压恢复正常。虽然这是一个相对较小的系列病例，但这些患有广泛病变的患者均取得了良好的效果，表明体外肾动脉重建是一种安全有效的治疗方法。因此，它应该具有更广泛的适用性，特别是对于那些以前被认为无法手术或仅适合肾切除的肾血管疾病患者。
