摘要
目的 探讨离体肾输尿管镜碎石手术治疗供肾结石的安全性及疗效.方法 亲属肾移植供者,女,39岁,CT检查示左肾(供肾)下盏结石.行腹腔镜下左侧供肾切取术+离体输尿管镜碎石术.术中供肾取出后迅速置入冰盐水中,用肾保护液充分灌注,采用Pull-up技术从离体输尿管断端置入F8.0/9.8输尿管硬镜,以减小进镜过程中对管腔黏膜的创伤.旋转离体肾脏,改变肾盂输尿管角度,使输尿管硬镜得以进入下盏,镜下采用钬激光将结石粉碎冲出.结果供肾热缺血时间3 min,冷缺血时间2.5 h.离体肾碎石取石时间18 min,手术当日尿量6260 ml.术后第1天肌酐402μmol/L,第2天肌酐186μmol/L,第3天肌酐136μmol/L,第4天肌酐112μmol/L,降至正常.随访6个月,肌酐维持在100μmol/L左右.结论 供肾切取术后离体肾输尿管镜碎石术治疗供肾结石安全有效.
Objective To propose ex vivo ureteroscopy (ExURS) and technical modification to render the donated kidney stone-free at live donor renal transplantation.Methods A suitable kidney donor with small unilateral nonobstructive calculi in the lower calyx of left kidney underwent laparoscopic live donor nephrectomy. After cold perfusion, ExURS was performed immediately in an iced saline solution. A F8.0/9.8 semirigid ureteroscope was accessed to collecting system via the ureteral stump. A 'Pull-up'skill was applied in order to facilitate the atraumatic access to the pelvis. The harvested kidney was rotated so as to facilitate the semirigid ureteroscope access to the lower calyx. The calculi was then completely endoscopic fragmented with holmium and removed. Results The warm ischemia time was 3 min and the cold ischemia time was 2.5 h. The procedure time was 18 min. There were no intra-operative or postoperative ureteral complications. The urine volume of recipient was 6260 ml in the postoperative day. the serum creatinine of 1 to 4 postoperative days were 402 μmol/L, 186 μmol/L, 136 μmol/L, 112 μmol/L, respectively, which was normal 4 days after operation. The serum creatinine maintain at 100 μmol/L approximately, in 6 months follow up.Conclusions ExURS is a technically feasible means of rendering a stone bearing donor kidney stone-free safely and efficiency.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第S1期54-56,共3页
Chinese Journal of Urology
关键词
肾移植
离体
输尿管镜碎石术
Kidney transplantation
Ex vivo
Ureteroscopic lithotripsy
