Shortell C K, Welch E L, Ouriel K, Green R M, DeWeese J A
Department of Surgery, University of Rochester School of Medicine and Dentistry, N.Y., USA.
Ann Vasc Surg. 1995 Jan;9(1):123-8. doi: 10.1007/BF02015326.
The presence of horseshoe kidney in conjunction with abdominal aortic disease significantly increases the technical difficulty of aortic reconstruction. Preservation of the renal blood supply and collecting system during the surgical procedure is the goal of operative management. The pertinent issues that remain unresolved include the need for specific preoperative studies, the optimal operative approach and the safety of isthmus division. From 1979 to 1994 eight patients with horseshoe kidney underwent operative intervention for aortic disease. Five men and three women who had a mean age of 66 years underwent seven reconstructions for aneurysmal disease and one for aortoiliac occlusive disease. All operations were elective and the transperitoneal approach was used in all cases. In the patients with aneurysmal disease the mean maximal aortic diameter was 7.3 cm. The mean preoperative serum creatinine value was 1.1 mg/dl. Preoperative identification of horseshoe kidney was accomplished in all seven patients with aneurysmal disease but not in the patient with occlusive disease. The anomaly was correctly identified by CT scan in seven of seven (100%) patients, arteriography in two of eight (25%) patients, ultrasonography in two of seven (29%) patients, and renal scan in one patient. In the three patients who underwent intravenous pyelography (IVP) the caliceal system was demonstrated to be completely separate from the isthmus. Renal artery anomalies were present in six (75%) patients; in three (50%) these anomalies could be not visualized on the preoperative arteriogram. Renal revascularization was accomplished by a variety of techniques, including reimplantation of multiple (one patient) and single (four patients) renal arteries and branch grafting to an individual renal artery (one patient).(ABSTRACT TRUNCATED AT 250 WORDS)
马蹄肾合并腹主动脉疾病会显著增加主动脉重建的技术难度。手术过程中保留肾血供和集合系统是手术治疗的目标。尚未解决的相关问题包括是否需要进行特定的术前检查、最佳手术入路以及峡部分离的安全性。1979年至1994年，8例马蹄肾患者因主动脉疾病接受了手术干预。5名男性和3名女性，平均年龄66岁，7例因动脉瘤性疾病接受了重建手术，1例因主髂动脉闭塞性疾病接受了手术。所有手术均为择期手术，所有病例均采用经腹入路。动脉瘤性疾病患者的主动脉平均最大直径为7.3厘米。术前血清肌酐平均值为1.1毫克/分升。7例动脉瘤性疾病患者术前均确诊为马蹄肾，但闭塞性疾病患者未确诊。7例患者中7例（100%）通过CT扫描正确识别了该异常，8例患者中2例（25%）通过动脉造影识别，7例患者中2例（29%）通过超声检查识别，1例患者通过肾扫描识别。3例行静脉肾盂造影（IVP）的患者显示肾盂系统与峡部完全分离。6例（75%）患者存在肾动脉异常；其中3例（50%）术前动脉造影未显示这些异常。通过多种技术实现了肾血管重建，包括多支（1例患者）和单支（4例患者）肾动脉再植以及向单支肾动脉进行分支移植（1例患者）。（摘要截断于250字）
