Department of Urology, The First Affiliated Hospital of Nanjing Medical University, China.
Eur J Vasc Endovasc Surg. 2011 Dec;42(6):803-8. doi: 10.1016/j.ejvs.2011.09.005. Epub 2011 Oct 5.
To evaluate the feasibility of combined laparoscopic technique for different types of vascular reconstruction in the treatment of Takayasu renal artery stenosis.
Retrospective study of seven cases of renal artery stenosis caused by Takayasu arteritis (TA).
Institutional practice and hospitalised patients. All these patients manifested renal arterial hypertension and failed to percutaneous transluminal angioplasty (PTA) treatment. Different types of revascularisation using hybrid laparoscopic technique were applied.
Laparoscopic renal artery isolation and kidney mobilisation were first performed. Several types of vascular reconstruction were performed as two patients underwent autotransplantation, four patients aortorenal bypass and one splenorenal bypass. For bypass patients, hypogastric artery was harvested by laparoscopic approach while saphenous vein and spleen artery were dissected by conventional opening. Autotransplantation and arterial anastomosis were then performed through an open incision.
All procedures were performed successfully without major intraoperative complications. The total operative time was 191 (130-280) min while laparoscopic part was 62 (40-105) min. The mean blood loss was 261 (150-400) ml. Postoperative blood pressure returned to normal in five patients but two others required single-agent antihypertensive medication. Minor complications included lumbar artery injury and flank pain each in one case. The anastomosis was patent in all patients and no re-stenosis occurred during 6-40 months of follow-up.
Hybrid laparoscopic techniques involving renal artery dissection and hypogastric artery harvesting are feasible in surgical treatment of Takayasu renal arteritis. This hybrid surgical technique provides an alternative approach to revascularise the renal circulation, especially for the patients of PTA treatment failure.
评估联合腹腔镜技术治疗 Takayasu 肾动脉狭窄不同类型血管重建的可行性。
回顾性研究 7 例由 Takayasu 动脉炎（TA）引起的肾动脉狭窄患者。
机构实践和住院患者。所有这些患者均表现为肾动脉高血压且经皮腔内血管成形术（PTA）治疗失败。应用杂交腹腔镜技术对不同类型的血管重建进行治疗。
首先进行腹腔镜肾动脉隔离和肾脏游离。2 例患者行自体移植，4 例患者行主动脉-肾旁路移植术，1 例患者行脾-肾旁路移植术，共进行了 4 种不同类型的血管重建。对于旁路手术患者，通过腹腔镜技术获取腹下动脉，通过传统切口游离大隐静脉和脾动脉。然后通过开放切口进行自体移植和动脉吻合。
所有手术均顺利完成，无重大术中并发症。总手术时间为 191（130-280）min，腹腔镜部分为 62（40-105）min。平均失血量为 261（150-400）ml。术后 5 例患者血压恢复正常，另外 2 例需要单一降压药物治疗。轻微并发症包括 1 例患者出现腰动脉损伤和 1 例患者出现腰痛。所有患者吻合口均通畅，随访 6-40 个月无再狭窄发生。
涉及肾动脉解剖和腹下动脉获取的杂交腹腔镜技术在 Takayasu 肾动脉炎的外科治疗中是可行的。这种杂交手术技术为重建肾循环提供了一种替代方法，特别是对 PTA 治疗失败的患者。
