脾動脈移植による腎血行の改善

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At present, there remain a vast number of renal parenchymal diseases for which no curative operation is known. Many of these renal parenchymal diseases affect the renal circulation primarily or secondarily, incurring renal vascular insufficiency. Such vascular insufficiency is peripheral (parenchymal) rather than proximal (within the main renal arterial supply). The author focused this investigations on the methods of early reestablishment of the adequate blood supply in these paticular situations. In this investigation, twenty-four adult mongrel dogs weighing 10 to 20 Kg. were devided into three groups; 1) ischemic kidney group (main experiment), 2) obstructed kidney group (that means complete obstruction of the renal artery), 3) normal kidney group. The peripheral revascularization of the renal parenchyma attempted by implanting the artificially formed aneurysmal splenic artery. On each group, effect of the implanted artery were evaluated by I.V.P., aortography, renal angiography, histologic examination, BUN and alterations of serum electrolytes and blood pressure. Aortography and I.V.P. were inadequate to evaluate the revascularization. Renal angiograms and histological studies demonstrated obvious vascular communication between implanted artery and renal vascular system on all groups. Newly developed renal revascularization was the most pronounced on the ischemic group followed by the obstructed and the normal control group in decreasing order. Renal angiogram and histological studies of ischemic and obstructed kidneys proved the blood from the implanted artery circulated into the glomerulus first, and then to the renal vascular system. And the india ink injected into the aorta entered the glomeruli under the physiological state, through the implanted artery. Conclusions: 1) The best renal revascularization was obtained when the aneurysmal splenic artery, produced artificially by stripping the tunica external, was implanted. 2) Vascular communication between the implanted artery and the renal vascular system was observed 14 days postoperatively. 3) Direction of the blood flow in the ischemic and the obstructed kidneys was as follows; Implanted artery- Revascularized artery- Afferent artery- Glomerulus- Efferent artery. 4) An increase in number of arteries implanted meant the better revascularization. 5) Currently studies are underway to implant more arteries utilizing, both the mesenteric and the splenic arteries for better renal revastularization, and clinical application is forthcoming.
社団法人日本泌尿器科学会の論文

脾動脈移植による腎血行の改善

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