RESUMEN
Objective:To investigate the effects and advantages of parachute technique in arterial anastomosis of living-donor renal transplantation with anatomical variations of renal artery.Methods:A total of 79 pairs of donors and recipients who received living-donor renal transplantation at the Department of Urology, Beijing Friendship Hospital, Capital Medical University from January 2020 to November 2022 were retrospectively collected. 11 pairs with completeness data and multiple donor renal arteries were selected. According to the different techniques, the cases using parachute technique were classified as experimental group and other cases as control group using traditional two-three-point fixation technique. There were 5 pairs in the experimental group and 6 pairs in the control group. The medical records of the two groups were collected, containing general data, the state of donated kidney, the arterial reonstruction method, the condition of perioperation and recovery of recipients. Measurement data were expressed as mean ± standard deviation ( ± s). Student- t test was used for inter-group comparison. The Chi-square test or Fisher exact probability method were used to compare the count data of groups. Results:The donations of experimental group and control group were left-sided kidney. There were no statistical difference in age, gender, body mass index and estimated glomerular filtration rate of donors and recipients. The average number of renal arteries in the experimental group was 2.2, and that in the control group was 2.0. There were no statistical difference between the two groups in the mean time of transplantation surgery[(152.0±23.9) min vs (148.3±24.0) min], estimated blood loss [(90.0±41.8) mL vs (91.7±58.5) mL] and mean arterial anastomosis time [(21.0±5.4) min vs (20.8 ± 4.7) min]. At the end of arterial anastomosis, no case in the experimental group need acupuncture or secondary anastomosis, while the control group had 3 cases, the difference was statistically significant ( P=0.002). There was no statistical difference in the recovery of renal function and complications related to renal arteries between the two groups ( P>0.05). Conclusions:Parachute suture technique can more accurately achieve the purpose of layer-to-layer eversion suture of vascular wall under the condition of narrow arterial lumen, and will not significantly prolong the operation time. It may have a good application value in living kidney transplantation with renal artery variation.
RESUMEN
Introducción: Conocer y diagnosticar las variaciones más frecuentes de la vasculatura renal es de gran importancia para la planificación de la nefrectomía laparoscópica en el donante y para la reconstrucción vascular en el trasplante renal. De igual forma, considerar las variaciones vasculares -especialmente las del sistema venoso- es indispensable en reconstrucción vascular debido a la gran proporción de variaciones venosas asociadas a aneurismas de la aorta abdominal; además, es ideal en el estudio de condiciones clínicas tales como el síndrome de congestión pélvica y la hematuria. Metodología: Se trata de una revisión de la bibliografía sobre la proporción, diagnóstico, procedimientos quirúrgicos y síndromes clínicos asociados a las variaciones de la vasculatura renal, basada en el material encontrado con la siguiente estrategia de búsqueda: "Renal Artery/abnormalities"[Mesh] OR Renal Veins/abnormalities"[Mesh] AND "surgery"[Mesh] OR "transplantation"[Mesh] OR "radiography"[Mesh] "Kidney Pelvis/abnormalities"[Mesh] AND "Kidney Pelvis/blood supply"[Mesh]. Esta estrategia se modificó de acuerdo con las bases de datos: MEDLINE/PubMed, MEDLINE OVID, SCIENCEDIRECT, HINARI y LILACS. Desarrollo: Se revisó el origen y los tipos más frecuentes de variaciones de la vasculatura renal. Se investigó sobre las implicaciones quirúrgicas y los síndromes clínicos asociados.
Introduction: Precise knowledge of the most frequent types of renal vascular anatomical variations, as well as the adequate clinical evaluation is of great importance during laparoscopic donor nephrectomy and during renal vascular reconstruction using kidney allografts with multiple vessels. Equally important is to consider the venous anatomical variations during abdominal vascular reconstruction, particularly when performing an abdominal aortic aneurysm repair, because of the outstanding proportion of renal vascular variations that are associated with this pathology. In addition, it is ideal to think carefully about these variations when a pelvic congestion syndrome or hematuria diagnosis is encountered. Materials and methods: This paper reviews the incidence, diagnosis, surgical procedures, and clinical syndromes associated with renal anatomical vascular variations. We conducted this review taking into account the following Mesh terms: "Renal Artery/abnormalities"[Mesh] OR Renal Veins/abnormalities"[Mesh] AND "surgery"[Mesh] OR "ransplantation"[Mesh] OR "radiography"[Mesh] "Kidney Pelvis/abnormalities"[Mesh] AND "Kidney Pelvis/blood supply"[Mesh]. These terms were adapted with each of the database that was consulted: MEDLINE/PubMed, MEDLINE OVID, SCIENCEDIRECT, HINARI and LILACS. Development: The source and the most frequent types of the vascular anomalies of the kidney were reviewed. We investigated about the associated clinical syndromes and the surgical consequences in kidney transplant.
Introdução. Conhecer e diagnosticar as variações mais freqüentes da vasculatura renal é de grande importância para a planificação da nefrectomia laparoscópica no doador e para a reconstrução vascular no transplante renal. De igual forma, considerar as variações vasculares -especialmente as do sistema venoso- é indispensável em reconstrução vascular devido à grande proporção de variações venosas associadas a aneurismas da aorta abdominal; além disso, é ideal no estudo de condições clínicas tais como a síndrome de congestão pélvica e a hematúria. Metodologia. Trata-se de uma revisão da bibliografia sobre a proporção, diagnóstico, procedimentos cirúrgicos e síndromes clínicas associadas às variações da vasculatura renal, baseada no material encontrado com a seguinte estratégia de procura: "Renal Artery/abnormalities"[Mesh] OR Renal Veins/abnormalities"[Mesh] AND "surgery"[Mesh] OR "transplantation"[Mesh] OR "radiography"[Mesh] "Kidney Pelvis/ abnormalities"[Mesh] AND "Kidney Pelvis/blood supply"[Mesh]. Esta estratégia se modificou de acordo com as bases de dados: MEDLINE/PubMed, MEDLINE OVID, SCIENCEDIRECT, HINARI y LILACS. Desenvolvimento. Se revisou a origem e os tipos mais freqüentes de variações da vasculatura renal. Se investigou sobre as implicações cirúrgicas e as síndromes clínicas associadas.