活体供肾肾移植的血管应用解剖.pdf

·1138· Chinese Journal of Reparative and Reconstructive Surgery, September 2009, Vol. 23, No.9 ? 综 述 ? 活体供肾肾移植的血管应用解剖 张际青 张小东 【摘 要】 目的 总结活体供肾肾移植供受体的有关血管解剖。 方法 查阅近年有关亲属移植供受体血管解 剖的国内外文献，并进行综述。 结果 供受体血管解剖对病例选择、手术方案制定及远期效果均有重要作用。供体过早 分支和副肾动脉的存在常会影响手术侧、手术方式和吻合方式的选择，其损伤出血及静脉出血均是导致腹腔镜手术转开放 手术的重要原因。随着腹腔镜供肾切除的增多，术前准确肾静脉评估也越来越得到重视。多层螺旋 CT 可代替常规影像 学检查并能准确评估供肾血管、血管变异、肾病变、集合系统和其他相关解剖信息。 结论 详细了解供受体的肾血管解 剖不仅利于手术成功，还能促进活体供肾肾移植的发展。多层螺旋 CT 已成为供体术前首选“一站式”影像学检查方法。 【关键词】 活体供肾 受体 肾移植 血管解剖 多层螺旋 CT 中图分类号 ： R322.12 R699.2 文献标志码 ：A VASCULAR ANATOMY OF DONOR AND RECIPIENT IN LIVING KIDNEY TRANSPLANTATION/ZHANG Jiqing, ZHANG Xiaodong. Department of Urology, Beijing Chaoyang Hospital Af? liated to Capital Medicine University, Beijing, 100020, P.R.China. Corresponding author: ZHANG Xiaodong, E-mail: zxd581@263.net 【Abstract】 Objective To review the vascular anatomy of the donor and the recipient for the living kidney transplantation. Methods The recent literature about the vessels of donor and recipient in clinical applications was extensively reviewed. Results The pertinent vascular anatomy of the donor and recipient was essential for the screening of the proper candidates, surgical planning and long-term outcome. Early branching and accessory renal artery of the donor were particularly important to deciding the side of nephrectomy, surgical technique and anastomosing pattern, and their injuries were the most frequent factor of the conversion from laparoscopic to open surgery. With increase of laparoscopic nephrectomy in dono