单切口腹腔镜肾切取联合自体肾移植术治疗复杂医源性输尿管缺损

Laparoscopic nephrectomy with autotransplantation for the management of extensive itraogenic ureteral avulsion

目的:探讨腹腔镜下肾切取联合自体肾移植术治疗复杂医源性输尿管缺损的应用。方法:回顾性分析腹腔镜下肾切取联合自体肾移植术治疗复杂医源性输尿管缺损患者围手术期及随访资料。结果:2例患者均经腹膜腔手术切取肾脏并经同侧下腹部Gibson切口取出,行工作台修整肾脏后经同一切口延长后完成自体肾移植手术均获得成功,2例患者手术时间分别为265min和325min,估计手术失血量分别为50ml和100ml,肾热缺血时间分别为2min和3min,无术中及术后输血,无术后尿瘘等并发症。术后1周血清肌酐较术前明显好转。随访2～30个月,患者移植肾功能良好,肾功能稳定,无肾积水及结石复发等。结论:腹腔镜肾切取联合自体肾移植术治疗复杂医源性输尿管缺损有效,创伤小,可在急诊环境下安全实施。而熟练的腹腔镜技术、肾移植技术和谨慎的围手术期管理是该术式安全实施的重要保障。

Objective:To summarize the safety and efficacy of laparoscopic nephrectomy with autotransplantation for the management of extensive iatrogenic ureteral loss.Method:Two patients underwent laparoscopic nephrectomy with autotransplantation in emergency settings.After the ureteral avulsions were identified intraoperatively,the patients were transformed to be under general anesthesia,the kidneys with extensive ureteral avulsion were harvested by transperitoneal laparoscopic nephrectomy through Gibson incision and trimmed in 4℃ UW solution on the bench table.Then the incision was extended to expose the spontaneous iliac fossa,then renal autotransplantation with Boari bladder flap plasty was performed.Result:Two procedures were performed successfully in duration time of 265 and 325 min respectively,and the estimated blood loss was 50 and 100 ml respectively.The warm ischemia time was 2 and 3 min,and cold ischemia time for kidney was 100 and 150 min respectively.One right renal vein was extended by using allograft vena cava patch and the Boari bladder flaps were anastomosed with the renal pelvic.On the first day after transplantation,the urine volume was from 1 800 ml to 3 700 ml.There were no surgical complications.During the follow-up period of 2-30 months,kidney-graft function was normal and no recurrence of uronephrosis or renal calculus was found.Conclusion:Laparoscopic nephrectomy with autotransplantation in emergency settings is safe and effective with minimal invasion and less pain to the patients.The laparoscopic techniques and perioperative management help to make the process even with higher safety and better quality.