离体输尿管镜钬激光碎石联合Lifeport灌注处理公民逝世后器官捐献结石供肾

Ex vivo ureteroscopic holmium laser lithotrpsy combined with Lifeport perfusion treatment of calculi in DCD donor kidneys

目的探讨离体输尿管镜钬激光碎石联合Lifeport灌注处理公民逝世后器官捐献(donation after citizen's death,DCD)供肾结石后肾移植的临床效果。方法利用输尿管镜下钬激光碎石术处理DCD供肾结石,右肾结石5例,左肾结石5例。碎石手术全程供肾置于冰肾脏保存液中,低压、低温冲洗,钬激光功率为1.2~1.6 J/15~20 Hz。碎石后进行Lifeport机械灌注,而后行肾移植术,移植肾输尿管与受体膀胱常规吻合并留置6 F D-J管。结果 1例患者出现移植肾功能延迟恢复(delayed graft function,DGF),所有患者术后4周经膀胱镜拔除D-J管,术后随访3~22个月,彩色多普勒超声检查均未见移植肾积水,2例患者术后1年移植肾结石复发,但移植肾功能稳定。结论离体输尿管镜钬激光碎石联合Lifeport灌注处理DCD供肾结石是扩大供肾池的有效方法,临床疗效良好。

Objective To investigate the clinical effect of ex vivo ureteroscopic holmium laser lithotripsy combined with Lifeport perfusion on donation after citizen＇s death （DCD） donor kidney with calculi. Methods The calculi in DCD donor kidneys, were treated with ureteroseopic holmium laser lithotfipsy, including 5 cases of right kidney stones and 5 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 1.2 - 1.6 J / 15 - 20 Hz. After lithotripsy, all kidneys were preserved by Lifeport mechanical perfusion , and then renal transplantation was performed. The donor＇s renal ureter was routinely matched to the reeipient＇s bladder and the 6 F D-J tube was left, Results One patient had delayed recovery of renal function. All patients underwented cystoscopy at 4 weeks after operation for pulling out D-J tube. Patients were followed up for 3 to 22 months. No hydronephrosis was found in the color Doppler ultrasonography. Two patients encountered stone recurrence in graft kidney after one year of transplatation with stable kidney function. Conclusion Ex vivo ureteroscopic holmium laser lithotrpsy combined with Lifeport perfusion treatment of calculi in DCD donor kidneys is an effective method to expand the donor kidney pool, and the clinical curative effect is good.