Valeriani G, Cerbone V, Russo E, Sciano D, De Rosa P
AOU San Giovanni di Dio and Ruggi D'Aragona Hospital, Salerno, Italy.
Transplant Proc. 2010 May;42(4):1120-2. doi: 10.1016/j.transproceed.2010.03.047.
The problems deriving from the anatomic differences between the two harvested kidneys make the bench surgery necessary to solve some technical difficulties in transplantation. This condition is particularly real in the case of right kidney transplantation, especially in presence of arterial anomalies. In this study, we focused our attention on venous reconstruction in cases of short renal right veins. In 3 years, we performed 55 consecutive cadaveric renal transplants in patients with an end-stage chronic renal insufficiency. The right kidney was used in 30 patients, eight of whom had two or more arteries attached to a single aortic patch, and 22 had a single artery. In these right transplanted kidneys, the elongation of renal vein was performed end-to-side to the external iliac vein, reconstructing a "T-patch" (angular reconstruction) in 28 patients and a "linear" one in two cases. The vascular anastomoses had no thrombotic problems. We have followed the progress of the patients for more than 2 years; no one has lost the graft due to chronic rejection or other complications. In conclusion, elongation of the right renal vein with a T-patch constitutes a feasible, physiological procedure without vascular complications or apparent reverberations for graft blood flow.
由于两个获取的肾脏之间存在解剖学差异而产生的问题，使得进行台式手术以解决移植中的一些技术难题成为必要。这种情况在右肾移植中尤为突出，尤其是在存在动脉异常的情况下。在本研究中，我们将注意力集中在肾右静脉较短情况下的静脉重建。在3年时间里，我们连续对55例终末期慢性肾功能不全患者进行了尸体肾移植。30例患者使用了右肾，其中8例有两条或更多动脉附着于单个主动脉补片，22例有单条动脉。在这些右移植肾中，肾静脉延长采用端侧吻合至髂外静脉，28例患者重建了“T形补片”（角形重建），2例患者重建了“直线形”补片。血管吻合未出现血栓问题。我们对患者进行了超过2年的随访；没有患者因慢性排斥反应或其他并发症而失去移植肾。总之，采用T形补片延长右肾静脉是一种可行的生理性手术，不会出现血管并发症，对移植肾血流也无明显不良影响。
