马蹄肾型腹主动脉瘤的诊断与手术治疗特点

I. Kobza, Y. Mota, T. Kobza
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引用次数: 0

摘要

介绍。腹主动脉瘤的重建手术尽管在国际上有丰富的经验,但仍然是当前血管外科中最复杂的问题之一,特别是由于肾脏动脉血液供应的解剖变异及其发育异常,其中最常见的是马蹄形肾。血管化的特点,肾峡相对于主血管的位置,腹主动脉瘤重建的最佳方法的选择,导致手术的高风险。开放和血管内主动脉移植、穿过马蹄形肾峡部的可能性、重建额外肾动脉的可行性等问题仍然存在争议。的目标。马蹄肾型腹主动脉瘤的诊断与手术治疗进展。案例演示。在我们的观察中,在一位61岁的患者中,通过临床检查、实验室检查和诊断影像学检查,确诊为两个肾下腹主动脉瘤伴马蹄肾,这已成为手术干预的直接指征:排除肾下主动脉瘤血流,腹主动脉假体移植并将肾峡动脉重新植入假体中。本临床病例证实了开放手术技术的优势,采用经腹膜入路,不仅提供了足够的手术区域暴露,而且可以在不穿过马蹄肾功能峡部的情况下进行最佳的腹主动脉重建,同时保留了额外肾动脉的血流。结论。术前仔细评估伴有腹主动脉瘤的马蹄肾的血液供应特点,可以优化手术治疗策略,防止严重并发症的发生,并使患者完全康复。
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Features of Diagnosis and Surgical Treatment of Abdominal Aortic Aneurysms with a Horseshoe Kidney
Introduction. Reconstructive surgery of abdominal aortic aneurysms, despite significant international experience, remains one of the most complex issues of current vascular surgery, especially due to anatomical variability of arterial blood supply of the kidneys and abnormalities in their development, among which the most common is a horseshoe kidney. Features of vascularization, placement of the renal isthmus relative to the main vessels, the choice of the optimal method of abdominal aortic aneurysm reconstruction cause a high risk of surgery. The issues of open and endovascular aortic grafting, possibility of crossing the isthmus of the horseshoe kidney, feasibility of reconstruction of additional renal arteries still remain controversial. The aim. Improvement of the diagnosis and surgical treatment of abdominal aortic aneurysms with a horseshoe kidney. Case presentation. In our observation, in a 61-year-old patient, by clinical examination, laboratory and diagnostic imaging the diagnosis of two infrarenal abdominal aortic aneurysms with a horseshoe kidney was confirmed, that has become a direct indication for surgical intervention: exclusion of infrarenal aortic aneurysms from the blood flow, abdominal aortic prosthetic grafting with reimplantation of the renal isthmus arteries into the prosthetic graft. This clinical case confirms the advantages of open surgical technique, using transperitoneal approach, which not only provided sufficient exposure of the operating area, but also allowed to perform optimal reconstruction of the abdominal aorta without crossing the functioning isthmus of the horseshoe kidney with preservation of blood flow through additional renal arteries. Conclusion. Careful preoperative assessment of the peculiarities of the blood supply of the horseshoe kidney with coexistent abdominal aortic aneurysms allows to optimize the tactics of surgical treatment, prevent the development of severe complications and achieve complete recovery of the patient.
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0.20
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发文量
42
审稿时长
6 weeks
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