Petru Bordei, Elena Sapte, Dan Iliescu, Constantin Dina
Department of Anatomy, Faculty of Medicine Constanta, Ioan Vodă Str., No. 58, 900573 Constanta, Romania.
Surg Radiol Anat. 2007 Jul;29(5):367-71. doi: 10.1007/s00276-007-0224-2. Epub 2007 Jun 26.
Using dissection and plastic injection followed by corrosion as study methods, we describe 16 cases of gonadal arteries originating from the renal artery. Among them, in 12 cases (75%), we assessed this variation on a single gonadal artery while two gonadal arteries appeared in four cases (25%). In 13 cases (81.25%) the gonadal arteries were located on the left side and in only three cases (18.75%) they were on the right. In seven cases (43.75%), a unique gonadal artery that originated from a single renal artery, in three cases (18.75%) the gonadal artery started from the artery of the inferior segment that started from the anterior branch of the renal artery, in other three cases (18.75%), from the trunk of the renal artery, prior to its terminal ramification and in one case (6.25%), from the artery of the superior segment that started from the anterior branch of the renal artery. In five cases (31.25%), a single gonadal artery started from a supplementary renal artery, in four cases (25%), from double renal arteries (three from the inferior and one from the superior one) and in a single case, from triple renal arteries (from the inferior one). All the four cases (25%) of double gonadal arteries were located on the left. Within them, in two cases, the two gonadal arteries started from the renal artery (unique or supplementary) and in the other two cases, the lateral gonadal artery originated from the renal artery (unique or supplementary) and the medial one from the aorta. This vascular variation shows a significant importance for renal surgery, in partial or total nephrectomy or in the renal transplant as long as it may lead to the compromise of the gonadal blood supply, mostly when the gonadal artery with renal origin is unique, without a second one with aortic or other arterial origin. A gonadal artery with origin from an inferior polar renal artery may be injured during the percutaneous treatment of the syndrome of pielo-ureteral junction, so it becomes a major contraindication. Also, this anatomical variation enhances the importance of the arteriography or Doppler ultrasound examination of the renal hylum. Sometimes, the gonadal artery may pass posterior to the proximal ureter that can be disturbed in traject, leading to hydronephrosis.
采用解剖、塑料灌注后腐蚀等研究方法，我们描述了16例性腺动脉起源于肾动脉的病例。其中，12例（75%）为单条性腺动脉出现这种变异，4例（25%）为两条性腺动脉。13例（81.25%）性腺动脉位于左侧，仅3例（18.75%）位于右侧。7例（43.75%）中，单条性腺动脉起源于单一肾动脉；3例（18.75%）中，性腺动脉起自肾动脉前支发出的下段动脉；另外3例（18.75%）起自肾动脉主干，在其终末分支之前；1例（6.25%）起自肾动脉前支发出的上段动脉。5例（31.25%）中，单条性腺动脉起自副肾动脉；4例（25%）起自双肾动脉（3例起自下极肾动脉，1例起自上极肾动脉），1例起自三条肾动脉（起自下极肾动脉）。所有4例（25%）双侧性腺动脉均位于左侧。其中，2例双侧性腺动脉均起自肾动脉（单一或副肾动脉），另外2例中，外侧性腺动脉起自肾动脉（单一或副肾动脉），内侧性腺动脉起自主动脉。这种血管变异在肾手术中，无论是部分或全肾切除术还是肾移植中都具有重要意义，因为它可能导致性腺血供受损，尤其是当起源于肾的性腺动脉为单一动脉，而没有起源于主动脉或其他动脉的第二条性腺动脉时。起源于肾下极动脉的性腺动脉在经皮治疗肾盂输尿管连接部综合征时可能会受到损伤，因此成为主要的禁忌证。此外，这种解剖变异增加了肾门血管造影或多普勒超声检查的重要性。有时，性腺动脉可能走行于近端输尿管后方，从而干扰其走行，导致肾积水。
