相关肾供者肾结石

D. Perlin, I. Dymkov, A. Terentyev, A. Perlina, I. V. Alexandrov
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摘要

介绍。活体肾移植的长期效果要比尸体肾移植好得多。最近,由于活体供体短缺,一些中心开始使用无症状结石的活体供体的肾脏作为解决问题的潜在方法。然而,这种情况的最佳手术解决方案尚未得到发展。目的评价肾结石活体供者肾脏移植的结果,并与文献资料进行比较。材料和方法。在2012-2021年期间,我们诊所有3例肾脏结石的相关供体患者进行了肾移植。一名供体在肾切除术前一个月接受了微型经皮碎石术。另外两例同时行逆行碎石和腹腔镜供体肾切除术。在这些病例中,使用钬或铥激光来破坏结石。所有供体均行腹腔镜腹膜后肾切除术。所有的结石都被成功移除。供体在手术期间和手术后均无手术并发症。热缺血时间不超过3.5分钟。捐赠前结石取出手术的住院时间一般为10天,同时手术的住院时间分别为6天和4天。所有移植物均移植到相关受体。一例移植前接受血液透析治疗,另一例接受腹膜透析治疗。第三名受者接受了先发制人的移植(在透析开始之前)。所有病例的移植物功能都是立即的。在随访期间(9-57个月),供体和受体均未见肾结石的迹象。考虑单肾结石的潜在供体可能会增加活体供体肾移植的数量。同时RIRS和腹腔镜供体肾切除术可以考虑作为顺序手术或体外结石取出的替代方法。所提出的技术是可重复的,安全的,与住院时间的增加无关。
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Nephrolithiasis in related kidney donors
Introduction. Long-term results of renal transplantation from living donors are much better than the results of cadaveric transplantations. Recently, because of the shortage of living donors, some centers have started using kidneys from living donors with asymptomatic stones as a potential solution for the problem. However, the optimal surgical solution for such situations has not yet been developed.Aim. To evaluate our obtained transplantation results of using the kidneys from living donors with nephrolithiasis and compare them with the literature data.Material and methods. In the period from 2012-2021, renal transplantations in our clinic were done in three patients from related donors with stones in the kidney. One donor underwent mini-percutaneous lithotripsy one month prior to nephrectomy. The other two underwent simultaneous retrograde lithotripsy and laparoscopic donor nephrectomy. In these cases a holmium or thulium laser was used for the destruction of calculi. All donors underwent laparoscopic retroperitoneal nephrectomy.Results. All stones were successfully removed. There were no surgical complications in donors during and after procedures. Warm ischemia time did not exceed 3.5 minutes. The general length of hospital stay was 10 days in case of predonation stone removal surgery and 6 and 4 days in the cases of simultaneous procedures, respectively. All grafts were transplanted to related recipients. One of the recipients was treated with hemodialysis before transplantation, the other one with peritoneal dialysis. The third recipient underwent preemptive transplantation (before the start of dialysis). The graft function in all cases was immediate. During the follow-up period (9-57 months), no signs of nephrolithiasis were seen in either donors, or recipients.Conclusions. Consideration of potential donors with stones in one kidney might increase the number of living donor renal transplantation. Simultaneous RIRS and laparoscopic donor nephrectomy can be considered as an alternative to sequential operations or ex vivo stone extraction. The presented technique is reproducible, safe and was not associated with an increased length of hospital stay.
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