摘要
目的总结离体供肾钬激光碎石清石术处理结石供。肾的经验。方法分析1例采用后腹腔镜取肾、离体供肾钬激光碎石清石术后亲体肾移植的治疗经过及结果，并复习文献。供者肾动态结果显示左肾GFR38．7ml／min，右肾42．3ml／min，左肾下极两个肾盏内各有一枚1．0cm×0．5em的结石。后腹腔镜切取左肾后，离体肾脏采用4℃低温肾脏保存液灌注，行输尿管下钬激光碎石清石术，结石碎片用套石篮和取石钳出。移植后尿液迅速流出，约2mim后输尿管远端水肿，切断远端输尿管1em水肿部分后常规行输尿管一膀胱侧壁抗反流再植术，留置6F双J管。结果输尿管镜下町见离体。肾脏内直径为8mm和12mm的两枚结石，均成功取出，离体手术历时30min。移植肾血流灌注良好，热、冷缺血时间分别为60s和50min。随访8个月，供、受者均未见结石复发。结论采用后腹腔镜切取供肾、离体供肾钬激光碎石清石术处理结石供肾的亲属活体肾移植方法技术可行，既可保留供肾的完整性，且不影响移植肾功能。
Objective To evaluate the safety and efficacy of ex vivo ureteroscopy （ExURS） as means of rendering a donated kidney stone-free in a living related renal transplantation. Methods Clini- cal data were analysed of ExURS as means of rendering a donated kidney stone-free in a living related renal transplantation and relative literature was reviewed. The ECT results showed that GFR of left and right kid- ney was 38.7 and 42.3 ml/min respectively. The donor underwent a left laparoscopic donor nephrectomy. hnmediately after cold perfusion, ExURS was performed with 4 ~C ice-cold saline irrigation. Basket extrac- tion and holmium laser lithotripsy was performed. Calculi were fragmented with pneumatic intracorporeal lithotripsy and fragments were removed with forceps. F6 indwelling ureteral stents were kept during trans- plantation. Urine flowed out immediately after reperfusion of the allograft and the distal ureter appeared ede- ma 2 rain later. Routine ureter-bladder wall anti-reflux replantation was done after the resection of the edema part. Results Pyeloscopy was successfully performed. A total of 2 calculi, diameter 8, 12 mm, were vi- sualized in donor kidney. The ex vivo treatment time was 30 min. The warm and cold ischemia time was 60 s and 50 rain, respectively. There were no intraoperative complications. At a follow-up at 8 months, there was no recurrent calculi formation in the recipient and donor. Conclusion ExURS is technically feasible to render a stone-bearing kidney stone free without compromising ureteral integrity or renal allograft function.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第11期856-858,共3页
Chinese Journal of Urology
基金
陕西省社会发展攻关基金（2010K01-164）
关键词
活体供者
输尿管镜检查
肾结石
肾移植
离体
Living donors
Ureteroscopy
Kidney calculi
Kidney transplantation
Ex-vivo
