Justo-Janeiro Jaime Manuel, Orozco Eduardo Prado, Reyes Francisco J Roberto Enríquez, de la Rosa Paredes René, de Lara Cisneros Luis G Vázquez, Espinosa Alfonso Lozano, Naylor Jesús Mier
Department of Surgery, Angeles Hospital of Puebla, 2143 Kepler Street, Atlixcáyotl, Puebla 72190, Puebla, Mexico; Faculty of Medicine, Autonomous University of Puebla, 2902 South 13th Street, Volcanes, Puebla, Puebla, Mexico.
Department of Surgery, Angeles Hospital of Puebla, 2143 Kepler Street, Atlixcáyotl, Puebla 72190, Puebla, Mexico.
Int J Surg Case Rep. 2015;15:21-5. doi: 10.1016/j.ijscr.2015.08.008. Epub 2015 Aug 12.
The use of a horseshoe kidney in renal transplant remains controversial, when it is found in the evaluation of a living donor, anatomical, surgical and ethical issues are involved.
An uncomplicated horseshoe kidney was detected in a 51-year-old woman who was the only suitable donor for her 30-year-old son. Kidneys were fused in the inferior pole and no vascular or urinary abnormalities were detected during imaging evaluation. The surgical procedure was approved by the hospital transplant committee. A laparotomy was performed by means of a medial upper incision. The isthmus of the kidney was divided using a harmonic scalpel and the left segment was used; it had 2 arteries too distant to create a common one, thus anastomosed separately. The renal vein was side-to-side anastomosed to the right external iliac vein and a Lich-Gregoir ureteral implant was made. There were no intraoperative or postoperative complications in the donor who currently remains asymptomatic. Recipient developed a delayed graft function (DGF), and was discharged on the 12th day after surgery. After 24 months of surgery, renal function has remained stable with a serum creatinine of 128μmol/L (1.45mg/dL).
There are 7 reports of a horseshoe kidney from living donors in 8 patients without morbidity and a good long term outcome of all recipients.
If we anticipate a low operative risk and there is a suitable anatomy, we may consider the use of horseshoe kidneys from living donors a viable alternative.
马蹄肾用于肾移植仍存在争议，当在活体供体评估中发现马蹄肾时，会涉及解剖学、手术及伦理学问题。
在一名51岁女性中检测到一个无并发症的马蹄肾，她是其30岁儿子唯一合适的供体。双肾在下极融合，影像学评估未发现血管或泌尿系统异常。手术方案经医院移植委员会批准。通过上腹部正中切口进行剖腹手术。使用超声刀切断肾峡部，取用左侧肾段；该肾段有2条动脉，距离过远无法合成一条共同动脉，因此分别进行吻合。肾静脉与右侧髂外静脉进行端侧吻合，并进行了利奇-格雷戈尔输尿管植入术。供体术中及术后均无并发症，目前仍无症状。受体出现移植肾功能延迟恢复（DGF），术后第12天出院。术后24个月，肾功能保持稳定，血清肌酐为128μmol/L（1.45mg/dL）。
有7篇关于8例活体供体马蹄肾的报道，供体均无发病情况，所有受体长期预后良好。
如果预计手术风险较低且解剖结构合适，我们可以考虑将活体供体马蹄肾作为一种可行的选择。
