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病例报告：马蹄肾自体移植及肾血管重建的主-双髂动脉搭桥术。

Case report: Aortobiiliac bypass with autotransplantation of the horseshoe kidney and renal vascular reconstruction.

作者信息

Knochenhauer Elena, Behrendt Daniel, Zimmermann Uwe, Busemann Alexandra, Kersting Stephan

机构信息

Department of Surgery, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany.

Department of Surgery, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany.

出版信息

Int J Surg Case Rep. 2024 Oct;123:110247. doi: 10.1016/j.ijscr.2024.110247. Epub 2024 Sep 6.

DOI:10.1016/j.ijscr.2024.110247
PMID:39245014
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11409030/
Abstract

INTRODUCTION AND IMPORTANCE

This case report describes the rare encounter of a large infrarenal abdominal aortic aneurysm (AAA) and a horseshoe kidney (HEN), which was managed through comprehensive preoperative planning and effective multidisciplinary collaboration, with the patient being fully informed and consenting to the publication of data and images.

CASE PRESENTATION

The patient was referred to the Department of Vascular Surgery with increasing abdominal pain. Computed tomography angiography showed that the aneurysm was significantly advanced. For surgical correction of the aortic aneurysm, the horseshoe kidney was autotransplanted intraoperatively to ensure renal vascular reconstruction for further renal perfusion after treatment of the aneurysm.

DISCUSSION

Abdominal aortic aneurysm carries a significant risk of rupture, with more than half of ruptures being fatal before reaching the hospital. When the AAA occurs concomitantly with a HEN, detailed imaging is critical for planning the procedure, as the unusual arterial supply to the HEN complicates the procedure and requires careful strategies to protect renal function while treating the aneurysm.

CONCLUSION

The treatment of complex cases with severe disease manifestations and difficult anatomy requires careful planning to ensure effective treatment and optimise patient survival and quality of life.

摘要

引言与重要性

本病例报告描述了一例罕见的巨大肾下腹主动脉瘤（AAA）合并马蹄肾（HEN）的情况，该病例通过全面的术前规划和有效的多学科协作进行治疗，患者已充分知情并同意发表数据和图像。

病例介绍

该患者因腹痛加剧被转诊至血管外科。计算机断层血管造影显示动脉瘤进展显著。为了对主动脉瘤进行手术矫正，术中对马蹄肾进行了自体移植，以确保在治疗动脉瘤后进行肾血管重建以实现进一步的肾脏灌注。

讨论

腹主动脉瘤有很高的破裂风险，超过一半的破裂在到达医院之前是致命的。当AAA与HEN同时发生时，详细的影像学检查对于手术规划至关重要，因为HEN不寻常的动脉供应使手术复杂化，并且在治疗动脉瘤时需要谨慎的策略来保护肾功能。

结论

对于具有严重疾病表现和复杂解剖结构的复杂病例，治疗需要仔细规划，以确保有效治疗并优化患者的生存率和生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/67b27dcaea48/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/cd97fa971d1f/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/1852188b4f01/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/12eb7b057ef2/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/10de2805d68d/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/b5745a4a6336/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/5082facbd81f/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/c703508b6e08/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/67b27dcaea48/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/cd97fa971d1f/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/1852188b4f01/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/12eb7b057ef2/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/10de2805d68d/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/b5745a4a6336/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/5082facbd81f/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/c703508b6e08/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca86/11409030/67b27dcaea48/gr8.jpg

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