Hoff Mekhola, Leighton Philippa, Hosgood Sarah A, Nicholson Michael L
Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
J Surg Case Rep. 2020 Sep 14;2020(9):rjaa310. doi: 10.1093/jscr/rjaa310. eCollection 2020 Sep.
As there is usually considerable overlap in the renal venous drainage, it is often possible to ligate supernumerary transplant renal veins in order to simplify the implantation procedure. Nonetheless, decisions about whether to implant multiple veins can be difficult and are usually made subjectively. Here, we describe the use of intraoperative Doppler ultrasound as an adjunct to decision-making when there are two renal veins and a novel technique for the sequential anastomosis of dual veins. The kidney was reperfused after anastomosis of the main renal vein with the second vein clamped. On-table Doppler ultrasound demonstrated reversed flow in diastole indicating that the second renal vein also needed to be anastomosed. By clamping the external iliac vein inferior to the first venous anastomosis it was possible to complete the lower polar renal vein anastomosis to the external iliac vein without interrupting the perfusion of the kidney.
由于肾静脉引流通常有相当大的重叠，为简化植入手术，常常可以结扎多余的移植肾静脉。尽管如此，关于是否植入多条静脉的决定可能很困难，而且通常是主观做出的。在此，我们描述了在有两条肾静脉时术中使用多普勒超声辅助决策以及一种双静脉序贯吻合的新技术。在主肾静脉吻合且第二条静脉夹闭的情况下对肾脏进行再灌注。术中多普勒超声显示舒张期血流反向，表明第二条肾静脉也需要进行吻合。通过在第一个静脉吻合口下方夹闭髂外静脉，可以在不中断肾脏灌注的情况下完成下极肾静脉与髂外静脉的吻合。
