Murakami T, Makino Y, Suto Y, Yasuda K
Department of Cardiovascular Surgery, Oji General Hospital, Tomakomai, Japan.
J Cardiovasc Surg (Torino). 2004 Oct;45(5):501-4.
Abdominal aortic aneurysm (AAA) is rarely associated witha congenital pelvic kidney. To date only 11 cases have been reported in the literature in which a solitary pelvic' kidney was associated in only 1 patient. Repair of thesaneurysm is technically demanding because the abnormal origin of the renal arteries presents the problem of renal ischemia duringaortic cross-clamping. We report a case of a 77-year-old man who was found to have an AAA associated with a congenital solitary pelvic kidney. An abdominal aortography dearly showed 2 aberrant renal arteries, one of which originated from the aortic wall just above the aortic bifurcation and the other from the left common iliac artery. At surgery, we found other associated anomalies including malrotation of the gut and a left undescended testis. The surgical procedure consisted of an aneurysmorrhaphy followed by a tube graft replacement with therenal arteries being left intact to the distal aortic wall or below. Renal preservation during aortic cross-clamping was achieved by direct perfusion of the upper renal artery with cold lactated Ringer's solution together with topical cooling with ice slush. The patient's postoperative course was uneventful. Urinary output was satisfactory and serum creatinine level remained unchanged throughout his hospital stay. The renal preservation method used in this case was simple and effective.
腹主动脉瘤（AAA）很少与先天性盆腔肾相关。迄今为止，文献中仅报道了11例病例，其中仅1例患者伴有孤立性盆腔肾。修复这种动脉瘤在技术上要求很高，因为肾动脉的异常起源会在主动脉交叉钳夹期间出现肾缺血问题。我们报告一例77岁男性患者，发现其腹主动脉瘤与先天性孤立性盆腔肾相关。腹部主动脉造影清楚地显示有2条异常肾动脉，其中一条起源于主动脉分叉上方的主动脉壁，另一条起源于左髂总动脉。手术中，我们发现了其他相关异常，包括肠道旋转不良和左侧隐睾。手术过程包括动脉瘤缝合术，随后进行人工血管置换，肾动脉保留在远端主动脉壁或其下方保持完整。在主动脉交叉钳夹期间，通过用冷乳酸林格氏液直接灌注上肾动脉并同时用冰泥进行局部降温来实现肾保护。患者术后恢复顺利。尿量令人满意，整个住院期间血清肌酐水平保持不变。本病例中使用的肾保护方法简单有效。
