Lobe T E, Martin E W, Cooperman M, Vasko J, Evans W E
Ann Surg. 1978 Jul;188(1):71-8. doi: 10.1097/00000658-197807000-00012.
Prior experience with the rare combination of horseshoe kidney and significant atherosclerotic vascular disease suggests difficulty in intraoperative management, often requiring division of the renal isthmus or sacrifice of some renal tissue. Seven patients have been managed successfully over the past ten years at The Ohio State University Hospital. There were six men and one woman, ranging in age from 39 to 66 years. Of the five patients with abdominal aortic aneurysm, four had a pulsatile abdominal mass, three had abdominal pain, and one had back pain. The other two patients had progressively symptomatic aortoiliac disease. All seven patients had hypertension, easily controlled by medication. Critical diagnostic procedures are preoperative intravenous pyelogram (IVP) and abdominal aortic arteriogram. The IVP detected the previously unsuspected diagnosis in 100% of the cases. The arteriogram accurately located the aneurysm in relation to the renal vascular supply, and disclosed aberrant blood supply in three of four patients with aberrant vessels. All seven horseshoe kidneys were fused at the lower pole. The operative approach involves meticulous dissection of the aberrant blood supply to the kidneys, and mobilization of the isthmus for adequate retrorenal aortic exposure. In six of the seven patients, the grafts were placed posterior to the isthmus. There were no deaths, and there were no complications related to the presence of the horseshoe kidney. In three of the seven patients, hypertension improved. Patients with horseshoe kidney and aortic disease may be safely operated upon without damage to the kidney. IVP and selective angiography are essential to provide preoperative information.
既往马蹄肾合并严重动脉粥样硬化性血管疾病的罕见病例经验表明，术中管理存在困难，通常需要切断肾峡部或牺牲部分肾组织。在过去十年中，俄亥俄州立大学医院已成功治疗了7例患者。其中男性6例，女性1例，年龄在39至66岁之间。在5例腹主动脉瘤患者中，4例有搏动性腹部肿块，3例有腹痛，1例有背痛。另外2例患者患有进行性有症状的主髂动脉疾病。所有7例患者均患有高血压，药物治疗易于控制。关键的诊断程序是术前静脉肾盂造影（IVP）和腹主动脉造影。IVP在100%的病例中检测到了之前未被怀疑的诊断。动脉造影准确地确定了动脉瘤相对于肾血管供应的位置，并在4例有异常血管的患者中的3例中发现了异常血供。所有7个马蹄肾均在下极融合。手术方法包括仔细解剖肾脏的异常血供，并游离峡部以充分暴露肾后主动脉。7例患者中有6例将移植物置于峡部后方。无死亡病例，也没有与马蹄肾存在相关的并发症。7例患者中有3例高血压病情改善。马蹄肾合并主动脉疾病的患者可以安全地进行手术，而不会损害肾脏。IVP和选择性血管造影对于提供术前信息至关重要。
