离体肾肿瘤切除、肾重建和原位自体肾移植技术治疗复杂性肾错构瘤的临床应用  

Orthotopic auto-transplantation with extracorporeal tumor resection and renorrhaphy in the treatment of complex angiomyolipoma of the kidney

作　　者：熊玮[1] 吕骥[1] 陈放[1] 杜杨春[1] 钟山[1] 郭璞[1] 杨靖逸[2] 陈吉东[3] 杨洪吉[1] 冉清[1] 

机构地区：[1]四川省医学科学院,四川省人民医院器官移植中心(泌尿三区),成都610072 [2]四川省医学科学院,四川省人民医院放射科 [3]四川省医学科学院,四川省人民医院超声医学科

出　　处：《临床泌尿外科杂志》2016年第10期886-889,共4页Journal of Clinical Urology

摘　　要：目的:探讨离体肾肿瘤切除、肾重建技术应用于复杂肾错构瘤保留肾单位手术的安全性和可行性。方法:双源CT三维血管成像(CTA)确诊左侧复杂肾错构瘤2例,其中1例为左肾上极巨大错构瘤及肾窦错构瘤,1例为左肾窦内错构瘤。均实施手术切除病变肾脏,在离体后给予UW液灌注和低温保护肾脏,于体外实施肾错构瘤切除及肾实质重建,随后将重建肾脏原位移植于左侧腹膜后肾床。结果:手术均获成功,围手术期无严重并发症发生。术后2周复查肾彩色多普勒提示左腹膜后移植肾动脉及其分支血流通畅,肾实质血流灌注良好。术后4个月双源CT示左腹膜后移植肾动脉及其分支血流通畅无狭窄,肾静脉回流通畅,输尿管无狭窄。结论:离体肾肿瘤切除、肾重建和原位自体肾移植技术治疗复杂性肾错构瘤安全可行,并为治疗复杂性肾脏外科疾病提供了可行途径。Objective：To investigate the feasibility and safety of orthotopic auto-transplantation with extracorporeal tumor resection and renorrhaphy in the treatment of complex renal angiomyolipoma.Method：Two cases with complex renal angiomyolipoma involving the renal artery branches in the left kidneys were diagnosed by computed tomography angiography.After temporary nephrectomy,angiomyolipoma masses were removed in vitro and renorrhaphy was done with the kidney protected by hypothermia and cold perfusion using organ preservation solution,then the reconstructed kidneys were implanted into the original position by vascular anastomosis in situ.Result：The operations were performed successfully without any significant perioperative complications.The transplanted kidneys were both well perfused when the patients discharged two weeks after the surgery.The computed tomography angiography at fourth month after the operation demonstrated renal arteries,renal veins and renal parenchymas were well reconstructed.Conclusion：Orthotopic auto-transplantation with extracorporeal tumor resection and renorrhaphy is safe and feasible to manage complex renal angiomyolipoma and to preserve renal function.Also,it provides a surgical alterative for complex renal diseases.

关 键 词：肾错构瘤 保留肾单位手术 肾重建 肾移植 

分 类 号：R737.11[医药卫生—肿瘤] R699.2[医药卫生—临床医学]