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題名 | Renal Autotransplantation for Ureter Stricture and Renovascular Disorders=應用自體腎移植治療輸尿管狹窄以及腎臟血管病變 |
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作者姓名(中文) | 莊正鏗; 朱聖賢; 廖順奎; | 書刊名 | 長庚醫學 |
卷期 | 22:4 1999.12[民88.12] |
頁次 | 頁621-626 |
分類號 | 416.273 |
關鍵詞 | 自體移植; 腎臟; 動脈瘤; 狹窄; Autotransplantation; Kidney; Aneurysm; Stricture; |
語文 | 英文(English) |
中文摘要 | 背景:經由腎臟移植之經驗,泌尿科醫師可以利用施行自體腎移植枝術來治療腎 血管疾患,上泌尿道腫瘤,複雜性輸尿管病變及腎臟損傷而仍舊保留腎功能。我們報告4例 自體腎移植之經驗,並討論其方法,適應症與結果。 方法:4例個案平均年齡為35歲,其中1例為高安氏血管炎併腎動脈狹窄(Takayasu's artehtis),1例腎靜脈高壓併血尿典腰痛(核桃鉗症候群,Nutcracker syndromo),1例輸尿 管狹窄以及1例腎動脈血管瘤,自體腎移植於同側骨盆腔。 結果:平均手術時間為7小時(4.5至8.5小時),冷凍缺血時間介於45至150分鐘(平均約 88分鐘)。有3例自體腎移植獲致成功,1例腎動脈血管瘤則因血管栓塞而失敗。 結論:自體腎臟移植是一項針對腎臟及輸尿管病變之有效治療方法。為避免因輸尿管血液回 流而導致血管栓塞,我們建議對於需要較長時間重建血管之病例,輸尿管之截斷以及完全之 腎血管灌注是有必要的。 |
英文摘要 | Background: Renal autotransplantation is an established therapy in cases of renal vascular lesions, tumors of the kidney and ureter, complex ureteral lesions, and kidney trauma. It has been a significant technical innovation, aiding the urologist in his great effort to preserve renal function by conserving renal tissue. We report our experience with autotransplantion in 4 patients. The indications, techniques, and results of renal autotransplantation in relation to our own experience are discussed. Methods: The patients included 3 women and one man. The average age of the patients was 35 years old, with a range from 20 to 54 years. One patient had Takayasu's arteritis, the second had Nutcracker syndrome with flank pain and hematuria, the third a complicated long ureter stricture, and the fourth patient a renal artery saccular aneurysm. Results: The average operation time was 7 hours (4.5 to 8.5 hours), and the cold ischemia time was about 88 minutes (45 to 150 minutes). Three of the autografts resumed normal renal perfusion, and in the fourth patient the renal autograft was lost due to vascular thrombosis. Conclusion: Renal autotransplantation is a feasible method for the surgical treatment of renal and ureteral lesions. To avoid postoperative ureteral sloughing and subsequent urinary fistulas, the ureter can be left intact to preserve the ureter blood supply. However, in the case of a complicated vascular reconstruction procedure, it appears to be appropriate to divide the ureter and have the kidney completely free, thus avoiding back-flow perfusion from the intrinsic and intercommunicating blood supply in the ureteral wall, which may result in vascular thrombosis and subsequent autograft failure. |
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