离体结石供肾经输尿管镜下钬激光碎石处理后行肾移植三例报告  

Ex vivo ureteroscopic treatment of calculi in donor kidneys before renal transplantation： three cases report

作　　者：陈传宝[1] 赵亮[2] 王小平[1] 韩明[1] 周健[1] 袁小鹏[1] 焦兴元[1] 王长希[3] 何晓顺[1] 

机构地区：[1]中山大学附属第一医院东院器官移植三区,广州510700 [2]中山大学附属第一医院泌尿外科,广州510700 [3]中山大学附属第一医院器官移植二区

出　　处：《中华器官移植杂志》2016年第4期220-223,共4页Chinese Journal of Organ Transplantation

摘　　要：目的观察离体结石供肾经输尿管镜下钬激光碎石处理后行肾移植的效果，总结体会。方法回顾性分析2012年至2015年间3例肾结石供者的相关资料及受者手术和术后随访资料。3例供者均为公民逝世后器官捐献（DCD）供者，术前评估肾功能良好，供肾获取前血肌酐分别为47μmol／L、49μmol／L、110μmol／L。共获取3只结石供肾，均为多发结石，最大结石分别为20mm×10mm、8mm×4mm和8mm×6mm；3只供肾移植前均在离体状态下经输尿管镜下钬激光碎石术。结果碎石过程均顺利，碎石耗时分别为45min、30min和25min。3例受者顺利完成肾移植手术，术后。肾功能均立即恢复，术后未发生移植肾功能延迟恢复、急性排斥反应及输尿管坏死、尿瘘等并发症。3例受者术后随访时间为3～36个月，移植肾功能均保持稳定。1例受者术后1周发现移植肾下极有2个小结石，大小3～5mm，该男性受者肾功能稳定，血肌酐73μmol／L，估算肾小球滤过率（eGFR）为104ml／min／1．73m2，未出现梗阻及血尿等并发症。其余2例均未见结石复发，血肌酐及eGFR均在正常范围。结论离体输尿管镜下钬激光碎石术能够安全、有效的处理离体结石供肾，肾移植术后早中期效果良好，是增加器官来源的可靠途径。Objective To summarize the experience of kidney transplantation from donors with nephrolith who received ez vivo ureteroscopic treatment before transplantation. Method The transplantation data and follow-up data from 3 donors with nephrolith and recipients during 2012 to 2015 years in our center were retrospectively analyzed. All 3 donors were DCD donors, renal function was perfect in preoperative assessment and the serum creatinine levels separately were 47, 49 and 110 μmol/L before organ procurement. Three kidneys with stones were harvested and all of them had multiple calculi （a right kidney was discarded for staghorn calculi in inferior pole with hydrops）, the sizes of stone were 20 mm× 10 mm, 8 mm×4 mm and 8 mm× 6 mm respectively. All kidney stones were given ex vivo ureteroscopic treatment before kidney transplantation. Result The proceeding of fragment was smooth and the lithotomy time of the 3 kidneys was 45, 30 and 25 min respectively. Three recipients completed kidney transplantation successfully with immediate graft function posttransplantation. There were absented complications just as DGF, AR, ureteral necrosis and urine leakage and so on. The follow-up time of 3 recipients was 3 to 36 months, the renal function remained stable and regular ultrasound examinations were executed posttransplantation. Two stones in male recipient were detected in the inferior pole of renal allograft via ultrasound examination with the sizes being 3 to 5 ram. However, the renal function remained steady and no obstruction and hematuresis appeared. The present serum creatine level was 73 μmol/L and eGFR was 104 mL/min/1.73 m2. No stones were detected in 2 female recipients after transplantation by regular ultrasound examination.The present serum creatine level and eGFR were 73 μmol/L and 78 mL/min/l. 73 m2, and 74 μmol/L and 67 mL/min/1.73 m2 respectively. Conclusion Ex vivo ureteroscopy could safely and efficiently handle calculi in donor kidney and obtain good early-middle outcomes of kidney transplantation. It

关 键 词：肾移植 供者 肾结石 输尿管镜 钬激光 

分 类 号：R699.2[医药卫生—泌尿科学]