Çok arterli böbrek nakilleri: Erken dönem sonuçlarımız
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Tarih
2012
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Böbrek nakli için kullanılan organlarda en sık rastlanan anomali renal arterin sayısal anomalileridir. Çalışmamızda amacımız, kliniğimizde yapılan renal transplantasyon olgularında tespit ettiğimiz arter anomalilerini literatür eşliğinde değerlendirmektir. Gereç ve Yöntem: Hastaların 5’i kadın (%39), 8’i erkek (%61), yaş ortalaması 43.7 (22-73), ortalama takip süresi 30.5 ay (4-90) idi. Hastalardan 7’sine kadavradan, 6’sına canlıdan nakil yapılmıştı. On iki hastada çift, 1 hastada üç renal arter mevcuttu. Altı hastada arterler ex vivo pantolon tarzı yan yana rekonstrüksiyon yapılarak geniş tek arter haline getirildi ve eksternal iliyak artere uç-yan anastomoz yapıldı. Çok küçük alt polar arteri olan bir hasta da alt polar arter bağlandı. Bir hastada arterler ayrı ayrı in situ anastomoz yapıldı. Üç arteri olan hastada üst arterler pantolon tarzı anastomoz yapılarak eksternal iliyak artere uç-yan, alt polar arter ise A. epigastrika inferior’a uç uca anastomoz edildi. Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Konya, Türkiye Dr. Mehmet Erikoğlu E-posta: [email protected] Makale Geliş Tarihi: 18.05.2012 Makale Kabul Tarihi: 24.11.2012 Bu çalışma 12-16 Ekim 2011 tarihlerinde Antalya'da yapılan TONKKD VIII. Kongresi'nde poster olarak sunulmuştur. Bulgular: Dört hastada (%30.7) gecikmiş greft fonksiyonu, 1 hastada biyopsi ile doğrulanmış (%7.6) akut rejeksiyona rastlandı. Postoperatif dönemde 3 hastada müdahale gerektirmeyen lenfosel, 1 hastada cilt altı enfeksiyonu ve 1 hastada da perirenal hematom tespit edildi. Cilt altı enfeksiyonu antibiyotik tedavisi ile düzeldi. Perirenal hematom saptanan hastada hematom kendiliğinden rezorbe oldu. Sonuç: Çoklu renal arteri olan böbreklerin nakil işleminde kullanılması teorik olarak bazı riskleri de beraberinde getirmektedir. Uzamış soğuk ve sıcak iskemi süresi nedeniyle akut tübüler nekroz, gecikmiş greft fonksiyonu ve rejeksiyon daha sık görülebilmektedir. Çoklu renal arterlerde ex vivo pantolon anastomoz yaparak geniş ve tek bir renal arter anastomozunun vasküler komplikasyon riskini azaltabileceğini düşünmekteyiz.
Purpose: The most common anomaly seen in kidneys used for transplantation is numerical anomalies of the renal artery. The aim of our study is to discuss the artery anomalies we detected in renal transplantation cases in our clinic in line with the relevant literature. Materials and Methods: Five (39%) of the patients were female, 8 were male (61%) and their mean age was 43.7 (22-73), mean follow-up period was 30.5 months (4 to 90). For 7 of the patients, the organs were transplanted from a cadaver and 6 were transplanted from living donors. 12 patients had double, 1 patient had three renal arteries. Six patients were given ex vivo pant type side by side reconstruction to obtain a single large artery and the external iliac was anastomosed to the artery. In 1 patient with a small inferior polar artery, the inferior polar artery was ligated. In 1 patient, the arteries were positioned by in situ anastomosis one by one. In one patient with three arteries, the upper arteries were positioned by pant type anastomosis and anastomosed as a single artery, and the lower polar artery was anastomosed with the inferior epigastric artery end to end. Results: In four patients (30.7%) there was delayed graft function,1 patient (7.6%) developed acute rejection verified with biopsy. In the post-operative period, it was determined that 3 patients had lymphocele which did not require intervention, 1 patient had subcutaneous infection and 1 patient had perirenal hematoma. Subcutaneous infection recovered with antibiotic treatment. As for the patient with perirenal hematoma, the perirenal hematoma resorbed spontaneously. Conclusion: Using kidneys with multiple renal arteries for transplantation brings with it some theoretical risks. Tubular necrosis, delayed graft function and rejection can be seen more frequently due to elongated cold or hot ischemia time. We are of the opinion that large and single renal artery anastomosis obtained with ex vivo pant anastomosis application can decrease the vascular complication risk in multiple renal artery.
Purpose: The most common anomaly seen in kidneys used for transplantation is numerical anomalies of the renal artery. The aim of our study is to discuss the artery anomalies we detected in renal transplantation cases in our clinic in line with the relevant literature. Materials and Methods: Five (39%) of the patients were female, 8 were male (61%) and their mean age was 43.7 (22-73), mean follow-up period was 30.5 months (4 to 90). For 7 of the patients, the organs were transplanted from a cadaver and 6 were transplanted from living donors. 12 patients had double, 1 patient had three renal arteries. Six patients were given ex vivo pant type side by side reconstruction to obtain a single large artery and the external iliac was anastomosed to the artery. In 1 patient with a small inferior polar artery, the inferior polar artery was ligated. In 1 patient, the arteries were positioned by in situ anastomosis one by one. In one patient with three arteries, the upper arteries were positioned by pant type anastomosis and anastomosed as a single artery, and the lower polar artery was anastomosed with the inferior epigastric artery end to end. Results: In four patients (30.7%) there was delayed graft function,1 patient (7.6%) developed acute rejection verified with biopsy. In the post-operative period, it was determined that 3 patients had lymphocele which did not require intervention, 1 patient had subcutaneous infection and 1 patient had perirenal hematoma. Subcutaneous infection recovered with antibiotic treatment. As for the patient with perirenal hematoma, the perirenal hematoma resorbed spontaneously. Conclusion: Using kidneys with multiple renal arteries for transplantation brings with it some theoretical risks. Tubular necrosis, delayed graft function and rejection can be seen more frequently due to elongated cold or hot ischemia time. We are of the opinion that large and single renal artery anastomosis obtained with ex vivo pant anastomosis application can decrease the vascular complication risk in multiple renal artery.
Açıklama
Anahtar Kelimeler
Böbrek nakli, Çoklu renal arter, Renal anomali, Renal transplantation, Multiple renal arteries, Renal anomaly
Kaynak
Ulusal Cerrahi Dergisi
WoS Q Değeri
Scopus Q Değeri
Q3
Cilt
28
Sayı
4
Künye
Erikoğlu, M., Çolak, B., Tekin, A., Küçükkartallar, T., Tavlı, Ş. (2012). Çok arterli böbrek nakilleri: Erken dönem sonuçlarımız. Ulusal Cerrahi Dergisi, 28, 4, 197-200.
