输尿管软镜联合钬激光处理公民逝世后器官捐献结石供肾效果观察

Flexible Ureterorenoscopy and Laser Lithotripsy for the Treatment of Calculi in Donation after Citizen’s Death Donor Kidneys

目的探讨输尿管软镜联合钬激光处理公民逝世后器官捐献(donation after citizen’s death,DCD)离体肾结石后肾移植的临床效果。方法2013年7月至2020年7月于昆明市第一人民医院利用输尿管软镜联合钬激光碎石术处理离体肾结石,右肾2例,左肾2例。离体肾全程置于冰水中,碎石过程中低温、低压冲洗。离体肾取石后,采用Lifeport机械灌注后行肾移植手术,观察灌注压力和阻力系数。结果4例受者肾移植术后未出现并发症,2例移植肾功能延迟恢复,留置D-J管4周,术后B超随访2436个月,未见移植肾积水、输尿管扩张及移植肾结石复发。结论输尿管软镜联合钬激光处理离体肾结石后行肾移植是扩大供肾池的有效方法,效果良好。

Objective To investigate the clinical effect of ex vivo flexible ureterorenoscopy with laser lithotripsy on donation after citizen’s death(DCD)donor kidney with calculi.Methods The calculi in DCD donor kidneys,were treated with flexible ureterorenoscopy holmium laser lithotripsy,including2 cases of right kidney stones and 2 cases of left kidney stones.Crushed stone surgery throughout the kidney placed in the ice kidney preservation solution,low pressure,low temperature washing,holmium laser power was 0.8 J/25 Hz.After lithotripsy,all kidneys were preserved by Lifeport mechanical perfusion,and then renal transplantation was performed.The perfusion pressure and resistance coefficient were observed.Results Treatment was successful in all patients and no severe complications or mortality occurred.Two patients had delayed recovery of renal function.All patients underwented cystoscopy at4 weeks after operation for pulling out D-J tube.Patients were followed up for 24 to 36 months.No hydronephrosis ureteral dilatation and recurrence of renal allograft calculi was found in the color Doppler ultrasonography.Conclusion Renal transplantation with flexible ureteroscope combined with holmium laser for treatment of isolated renal calculi is an effective method to enlarge the donor pool with good results.