供肾结石工作台碎石手术技巧

The technigue of lithotripsy on donor kidney stone

目的:总结对供肾结石在移植前进行工作台输尿管镜取石的经验与技巧。方法:自2018年1月至2019年12月,首都医科大学附属北京友谊医院泌尿外科共有7例器官捐献供者在捐献前评估时发现存在供肾结石,并且均在修肾结束后行工作台输尿管镜激光碎石取石术。回顾性总结此7例供肾的基本情况、结石大小、位置、手术相关并发症以及清石效果。7例供者年龄为(49.6±6.8)岁。其中6例供肾为单纯肾盂结石,1例为输尿管上段结石。结果:7例结石直径为(1.2±0.5)cm(0.4~2.1 cm)。5例肾盂结石及1例输尿管结石均使用半硬性输尿管镜检查并行钬激光碎石,另外1例供肾在术中未发现结石。所有供肾平均手术时间为(23.0±6.1)min,并在碎石后对所有供肾均行常规低温机械灌注。结石侧供肾起始阻力指数高于同一供者对侧供肾(P<0.05),但两侧供肾的终末阻力指数差异无统计学意义。7例受者手术开放循环后均未发生严重血尿,且术后肾功能恢复良好。术后1个月复查CT显示,7例受者均无明显结石残留。结论:工作台手术是处理供肾结石的微创方法,比较安全有效。半硬性输尿管镜即可处理大部分供肾结石,但其中远期效果仍需进一步评估。

Objective To summarize the experience and skills of ex-vivo ureteroscopy that performed on deceased donor kidneys with gifted lithiasis on bench prior to transplantation.Methods From January 2018 to December 2019,a total of 7 death donors in Capital Medical University Beijing Friendship Hospital were found to have donor gifted lithiasis during pre-donation evaluation,and all of them underwent ureteroscope laser lithotripsy on bench before transplantation.We retrospectively analysied the demographic information of donors,stone size,location,operative complications and stone clearance rate of the total 7 donor kidneys.The mean age of donors was(49.6±6.8)years.The 7 gifted lithiasis consisted of 6 cases of simple pyelolithiasis and 1 case of upper ureteral calculi.Results The mean diameter of the stones was(1.2±0.5)cm(0.4~2.1 cm).The 5 cases of pyelolithiasis and 1 case of ureteral calculi were examined with semi-rigid ureteroscopy and then underwent holmium laser lithotripsy.The other 1 case had not found the stone during the bench operation.The mean lithotripsy time was(23.0±6.1)min,and all donor kidneys underwent hypothermic machine perfusion after lithotripsy.The initial resistance index(RI)of donor kidney with gifted lithiasis was higher than the other side of the same donor(P<0.05),but there was no statistical difference in end-point RI between the both sides.None of the 7 recipients had severe hematuria after operation and their renal function recovered well.CT scan at 1 month after the operation showed the clearance of stone was satisfied in all 7 recipients.Conclusions Bench surgery is a minimally invasive method for donor gifted lithiasis management,and it is relatively safe and effective.For most cases,the semi-rigid ureteroscopy can handle it well,but the long-term effect still needs to be further evaluated.