Abstract:

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 ureteroscopic holmium laser lithotripsy, 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 recipient'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.

摘要：

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。