肾离体手术在肾移植中的临床应用二例并文献复习  

Application of ex vivo operation in urological diseases:a report of 2 cases and literature review

作　　者：张更[1] 秦荣良[1] 邵晨[1] 秦卫军[1] 武国军[1] 杨力军[1] 杨晓剑[1] 刘飞[1] 王福利[1] 于磊[1] 李智斌[1] 马帅军[1] 刘克普[1] 阮东丽[1] 段策于[1] 袁建林[1] 

机构地区：[1]第四军医大学西京医院泌尿外科,西安710032

出　　处：《中华移植杂志（电子版）》2013年第1期13-15,共3页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的总结肾离体手术在肾移植中的临床应用经验。方法 2002年2月至4月第四军医大学西京医院泌尿外科分别行离体肾肿瘤剜除术后自体肾移植1例和离体供肾输尿管镜下钬激光碎石清石术后亲属活体肾移植1例。分析2例受者临床资料并进行文献复习。结果病例1:离体手术中肿瘤完整剜除,病理检查切缘未见癌组织,自体肾移植手术顺利;随访7个月,血清肌酐、血尿素氮水平略高于正常,无需透析,无肿瘤复发及转移。病例2:输尿管镜下可见离体供肾内两枚直径分别为8和12mm的结石,均成功取出;肾移植术中留置输尿管支架;术后未见相关并发症,随访10个月,移植肾内未见结石复发。结论肾离体手术有助于减少手术损伤,最大限度地维护患者肾脏功能,减少等待肾移植人群。正确选择适应证至关重要。Object To evaluate the safety and efficacy of ex vivo operation as means of treatment in special urological disease.Methods Case 1：Ex vivo tumor resection was performed on a 69-old-year man for renal cell carcinoma in a solitary kidney.The renal auto-transplantation was performed after the tumor resection.Case 2：A donor with small non-obstructing unilateral nephrolithiasis detected on preoperative CT angiography underwent donor nephrectomy.Immediately after cold perfusion,ex vivo ureteroscopy（ExURS） was performed with ice-cold saline irrigation.Basket extraction and holmium laser lithotripsy was performed.Calculi were fragmented with pneumatic intracorporeal lithotripsy and fragments were removed with forceps.Results Case 1：The renal cell carcinoma histological subtypes were clear cell and the patient survived with local recurrence-free and metastasis-free during the 7-month follow-up.Case 2：Pyeloscopy was successfully performed.A total of 2 calculi with diameters of 8 mm and 12 mm,respectively,were visualized in the donor kidney.Access to the renal collecting system and stone fragmentation was technically successful in this case.Indwelling ureteral stents were kept during transplantation.No intraoperative complications were noted.At a follow-up of 10 months no recurrent calculi formation was founded in the recipient.Conclusion Such ex vivo operations may offer the chance of curative therapy for patients with special urological diseases.

关 键 词：离体手术 供肾结石 亲属活体肾移植 孤立肾 自体肾移植 

分 类 号：R699[医药卫生—泌尿科学]