自体肾移植治疗儿童复杂肾动脉瘤1例。

Q3 Medicine
北京大学学报(医学版) Pub Date : 2025-04-18
Lei Yu, Wenbo Yang, Yufan Yang, Qiang Wang
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引用次数: 0

摘要

肾自体移植(RA)为复杂的肾血管疾病,如复杂的肾动脉瘤和肾动脉畸形的治疗提供了显著的技术优势。本文报告一例5岁儿童的复杂左肾动脉瘤合并多个动脉瘤。该儿童于2023年12月因一年的间歇性腹痛病史入住北京大学人民医院,过去一个月发现腹部肿块。计算机断层血管造影(CTA)显示多处血管异常,包括:(1)左肾动脉瘤,(2)腹主动脉瘤,(3)右髂动脉瘤。在对这些发现进行全面评估后,外科团队制定了一项治疗计划,包括切除左肾动脉瘤,自体左肾移植,并通过人工血管导管切除腹主动脉瘤。在手术中,发现左肾动脉的解剖结构非常复杂。该动脉有两个主要分支,以及位于下极的另一条极动脉。动脉瘤位于肾动脉干的远端,在肾动脉主干及其次级分支的交叉处有明显的膨出。由于这些结构的复杂性,研究小组决定采用体外手术方法修复动脉瘤。体外修复包括暂时将肾脏从体内取出,以更高的精度修复肾动脉瘤,使手术团队能够在没有体内操作限制的情况下精心重建复杂的血管结构。体外修复肾动脉瘤是成功的,允许准确的血管重建和避免潜在的术中并发症。重建后,肾脏被自动移植回儿童体内,血液有效地恢复了器官的流动。治疗结果非常好,患儿无术后并发症。病人恢复良好,出院时情况稳定。本病例强调了肾脏自体移植联合体外修复治疗小儿复杂肾动脉瘤的价值。通过本报告,我们旨在为肾脏血管解剖复杂的儿童类似病例的手术治疗提供见解和注意事项。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Renal autotransplantation for the treatment of complex renal aneurysm in a child: A case report].

Renal autotransplantation (RA) offers significant technical advantages for the management of certain complex renal vascular diseases, such as complex renal aneurysms and renal artery malformations. This report describes a case of a 5-year-old child with a complex left renal artery aneurysm combined with multiple aneurysms. The child was admitted to Peking University People's Hospital in December 2023 due to a one-year history of intermittent abdominal pain, with an abdominal mass detected in the past month. Computed tomography angiography(CTA) revealed multiple vascular anomalies, including: (1) a left renal artery aneurysm, (2) an abdominal aortic aneurysm, and (3) a right iliac artery aneurysm. After a comprehensive evaluation of these findings, the surgical team developed a treatment plan that involved the excision of the left renal artery aneurysm, autotransplantation of the left kidney, and resection of the abdominal aortic aneurysm with an artificial vascular catheterization. During surgery, it was discovered that the left renal artery anatomy was highly complex. The artery had two primary branches, along with an additional polar artery located at the lower pole. The aneurysm was identified at the distal end of the renal artery trunk, with a pronounced bulging at the intersection between the main renal artery trunk and its secondary branches. Due to these structural complexities, the team decided to use an ex vivo surgical approach to repair the aneurysm. Ex vivo repair involves temporarily removing the kidney from the body to repair the renal artery aneurysm with enhanced precision, enabling the surgical team to meticulously reconstruct the complex vascular architecture without the constraints of in vivo manipulation. The ex vivo repair of the renal artery aneurysm was successful, allowing for accurate vascular reconstruction and avoiding potential intraoperative complications. Following the reconstruction, the kidney was autotransplanted back into the child's body, and blood flow was effectively restored to the organ. The therapeutic outcome was excellent, with the child experiencing no postoperative complications. The patient recovered well and was discharged from the hospital in stable condition. This case underscores the value of renal autotransplantation combined with ex vivo repair for pediatric patients with complicated renal artery aneurysms. Through this report, we aim to provide insights and considerations for the surgical treatment of similar cases in children with complex renal vascular anatomy.

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来源期刊
北京大学学报(医学版)
北京大学学报(医学版) Medicine-Medicine (all)
CiteScore
0.80
自引率
0.00%
发文量
9815
期刊介绍: Beijing Da Xue Xue Bao Yi Xue Ban / Journal of Peking University (Health Sciences), established in 1959, is a national academic journal sponsored by Peking University, and its former name is Journal of Beijing Medical University. The coverage of the Journal includes basic medical sciences, clinical medicine, oral medicine, surgery, public health and epidemiology, pharmacology and pharmacy. Over the last few years, the Journal has published articles and reports covering major topics in the different special issues (e.g. research on disease genome, theory of drug withdrawal, mechanism and prevention of cardiovascular and cerebrovascular diseases, stomatology, orthopaedic, public health, urology and reproductive medicine). All the topics involve latest advances in medical sciences, hot topics in specific specialties, and prevention and treatment of major diseases. The Journal has been indexed and abstracted by PubMed Central (PMC), MEDLINE/PubMed, EBSCO, Embase, Scopus, Chemical Abstracts (CA), Western Pacific Region Index Medicus (WPR), JSTChina, and almost all the Chinese sciences and technical index systems, including Chinese Science and Technology Paper Citation Database (CSTPCD), Chinese Science Citation Database (CSCD), China BioMedical Bibliographic Database (CBM), CMCI, Chinese Biological Abstracts, China National Academic Magazine Data-Base (CNKI), Wanfang Data (ChinaInfo), etc.
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