de Virgilio C, Gloviczki P, Cherry K J, Stanson A W, Bower T C, Hallett J W, Pairolero P C
Department of Radiology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Cardiovasc Surg. 1995 Aug;3(4):413-20. doi: 10.1016/0967-2109(95)94161-o.
Renal fusion or ectopia can present formidable challenges during aortic surgery. To evaluate morbidity and define optimal management, the clinical histories of 20 patients with renal fusion or ectopia who underwent 21 aortic procedures at the authors' institution over a 37-year period were reviewed. Indications for surgery included aortic aneurysm in 16 patients (infrarenal in 15 and thoracoabdominal in one) and aortoiliac occlusive disease in five (with renovascular hypertension in two). The abnormal kidney was detected before surgery in 13 patients (65%) by excretory urography, arteriography, computed tomography, or ultrasonography. Arteriography revealed multiple and/or anomalous renal arteries in nine of 12 patients studied. At surgery, 15 patients (75%) were found to have multiple or anomalous renal arteries. Six required renal revascularization (reimplantation four, endarterectomy one, aortorenal bypass one). The renal symphysis was divided in two patients. There were no operative deaths. Six major complications included bleeding requiring reoperation, renal failure requiring short-term dialysis, pancreatitis, gastrointestinal bleeding, pneumonia and thrombophlebitis. Preoperative aortography is recommended in patients with renal fusion or ectopia because of the high incidence of associated renal artery anomalies. The surgeon must be prepared to preserve or revascularize these anomalous renal arteries. Division of the renal symphysis is rarely required. Although perioperative morbidity is raised, aortic reconstruction in patients with renal fusion or ectopia can be safely performed without increased mortality.
肾融合或异位在主动脉手术中可能带来巨大挑战。为评估发病率并确定最佳治疗方法，回顾了在37年期间于作者所在机构接受21例主动脉手术的20例肾融合或异位患者的临床病史。手术指征包括16例主动脉瘤患者（15例为肾下型，1例为胸腹型）和5例主髂动脉闭塞性疾病患者（2例伴有肾血管性高血压）。13例患者（65%）在手术前通过排泄性尿路造影、动脉造影、计算机断层扫描或超声检查发现了异常肾脏。在接受检查的12例患者中，9例动脉造影显示有多条和/或异常肾动脉。手术时，15例患者（75%）被发现有多条或异常肾动脉。6例需要进行肾血管重建（4例肾动脉再植，1例动脉内膜切除术，1例主动脉-肾动脉旁路移植术）。2例患者进行了肾联合分离术。无手术死亡病例。6例主要并发症包括需要再次手术的出血、需要短期透析的肾衰竭、胰腺炎、胃肠道出血、肺炎和血栓性静脉炎。由于合并肾动脉异常的发生率较高，建议对肾融合或异位患者进行术前主动脉造影。外科医生必须准备好保留这些异常肾动脉或进行肾血管重建。很少需要进行肾联合分离术。虽然围手术期发病率有所升高，但肾融合或异位患者的主动脉重建可以安全进行，死亡率不会增加。
