改良手助后腹腔镜活体取肾及自体肾移植治疗严重医源性输尿管缺损(附7例报告并文献复习)

Improved hand assisted laparoscopic living donor nephrectomy and renal transplantation for treatment of severe iatrogenic ureteral defects (a report of 7 cases and literature review)

目的探讨改良手助后腹腔镜活体取肾及自体肾移植治疗严重医源性输尿管缺损的手术技术和临床效果。方法对7例外院行输尿管镜气压弹道碎石术或单纯输尿管镜检术致输尿管长段撕脱缺损病例,在该院采用改良手助后腹腔镜切取患侧肾脏后,离体肾脏采用4℃低温肾脏保存液灌注,通过原取肾切口将肾脏移植于同侧髂窝。结果 7例手术均获成功,手术时间为(340±89)min、出血量为(110±39)ml、肾脏热缺血时间为(3±1)min和肾脏冷缺血时间为(80±27)min,多有研究对象均未出现围手术期并发症,术后2个月拔除双J管;术后3个月和6个月静脉肾盂造影(IVP)均提示肾功能正常,尿路通畅。结论改良手助后腹腔镜活体取肾及自体肾移植治疗严重医源性输尿管缺损微创、安全有效。

[Objective]To investigate the surgical technique and clinical effect of improved hand assisted laparoscopic living donor nephrectomy and renal transplantation in the treatment of severe iatrogenic ureteral defects.[Methods]Seven cases with ureteral avulsion defect caused by ureteroscopic pneumatic ballistic lithotripsy or simple ureteroscopy were selected,after the adoption of improved hand assisted laparoscopic resection in ipsilateral kidney,isolated kidney was perfused with low-temperature preservation solution,and was transplanted in the ipsilateral iliac fossa through the original renal incision.[Results]Seven cases were successful,the average operation time was（340±89） min,mean blood loss was（110±39） ml,mean renal warm ischemia time was（3±1） min,mean renal cold ischemia time was（80 ±27） min,and there was no perioperative complications.Double J tube was removed 2 months after operation.After 3 months and 6 months,intravenous pyelogram（IVP） showed normal renal function and urinary tract patency.[Conclusion]The improved hand assisted laparoscopic living donor nephrectomy and renal transplantation in the treatment of severe iatrogenic ureteral defects are minimally invasive,safe and effective.