Sampaio F J
Department of Anatomy, Biomedical Center, State University of Rio de Janeiro, Brazil.
J Endourol. 1996 Oct;10(5):411-5. doi: 10.1089/end.1996.10.411.
To maximize the success rate of endopyelotomy with minimal risk of complications, some debate still persists on the technique of incising the ureteropelvic junction (UPJ), patient selection, and prognostic factors. Also, some controversy exists concerning the vascular complications associated with the procedure. In order to give anatomic background to better clarifying the issue of a crossing vessel at the UPJ, we analyzed its vascular anatomic relations in 546 kidneys divided as following: 82 three-dimensional polyester resin corrosion endocasts of the collecting system together with the intrarenal arteries, 52 endocasts of the collecting system together with the intrarenal veins, 146 endocasts of the collecting system together with the intrarenal arteries and veins simultaneously, and 266 in situ dissected kidneys. In 65% of the endocasts, we found a prominent artery, vein, or both in close relation to the ventral surface of the UPJ. Among these cases, in 45%, the relation was with the inferior segmental artery. With respect to the presence of multiple renal arteries, in only 6.8% of the cases did an inferior polar artery cross anteriorly to the UPJ. In 6.2% of the endocasts, there was a direct relation between a large vessel and the dorsal surface of the UPJ. In additional 20.5% of the cases, there was a vessel crossing lower than 1.5 cm above the posterior surface of the UPJ. Considering these anatomic findings, it is conceivable that many of the vessels seen during angiography in a close relation to the UPJ and described as anomalous and etiologic in obstruction would be normal segmental arteries that do not cause UPJ obstruction. Also, on the basis of the anatomic findings, we advise that in endopyelotomy, the incision along the stenotic UPJ wall be created only at its lateral aspect.
为了在将并发症风险降至最低的同时使肾盂内切开术的成功率最大化，关于切开输尿管肾盂连接部（UPJ）的技术、患者选择和预后因素仍存在一些争议。此外，关于该手术相关的血管并发症也存在一些争议。为了提供解剖学背景以更好地阐明UPJ处交叉血管的问题，我们对546个肾脏的血管解剖关系进行了分析，分组如下：82个收集系统与肾内动脉的三维聚酯树脂腐蚀铸型，52个收集系统与肾内静脉的铸型，146个收集系统同时与肾内动脉和静脉的铸型，以及266个原位解剖的肾脏。在65%的铸型中，我们发现一条突出的动脉、静脉或两者与UPJ腹侧面关系密切。在这些病例中，45%的关系是与肾下段动脉。关于多支肾动脉的存在，仅6.8%的病例中存在下极动脉向前越过UPJ。在6.2%的铸型中，一条大血管与UPJ背侧面有直接关系。在另外20.5%的病例中，有血管在UPJ后表面上方低于1.5 cm处交叉。考虑到这些解剖学发现，可以想象在血管造影中看到的许多与UPJ关系密切且被描述为异常和梗阻病因的血管可能是不会导致UPJ梗阻的正常节段动脉。此外，基于解剖学发现，我们建议在肾盂内切开术中，沿狭窄的UPJ壁的切口仅在其外侧进行。
