摘要目的 探讨广州医科大学附属第二医院器官移植科应用自体肾移植术治疗严重输尿管损伤和复杂肾动脉瘤的经验并探讨其临床应用价值.方法 回顾性分析本中心2010年1月至2018年3月通过自体肾移植术治疗的2例复杂肾动脉瘤患者和6例严重输尿管损伤患者的临床资料.结果 8例手术均顺利完成,移植后肾功能迅速恢复,切取自体肾热缺血时间约为(3±1)min,总手术时间为(340±164)min,出血量为(180±60) ml.在肾动脉吻合方式中,6例严重输尿管损伤患者采用髂内动脉与肾动脉端端吻合,2例复杂肾动脉瘤患者采用肾动脉与自体髂内动脉重建后,再与髂外动脉行端侧吻合;7例行肾输尿管膀胱再植,1例行肾盂输尿管吻合术,围手术期和术后长期随访未发现血管及输尿管严重并发症,随访至2018年9月,肾功能正常,血压正常.结论 自体肾移植术可用于治疗严重的输尿管缺损和复杂肾动脉瘤,且安全可行,能最大程度地保存患者肾功能,为治疗复杂性泌尿外科疾病提供了可行途径.

abstractsObjective To summarize the experience of renal autotransplantation for severe iatrogenic proximal ureteral damage and renal artery aneurysms in eight patients and to explore the clinical application value of renal autotransplantation.Methods Two patients of renal artery aneurysms and six patients of severe iatrogenic proximal ureteral damage between January 2010 and March 2018 in our center were retrospectively reviewed.Results The procedures of eight cases were successful,with immediate return of renal function in the patients.The warm ischemia time was (3±1) minutes,the total operation time was (340 ± 164) min,and the estimated blood loss was (180 ± 60) ml,respectively.For renal artery anastomosis,six patients of severe iatrogenic proximal ureteral damage received end-to-end anastomosis between the internal iliac artery and renal artery,and two patients of renal artery aneurysms were treated with renal artery and internal iliac artery for reconstruction,then end-to-side anastomosis to recipien external iliac artery.A direct ureterovesical anastomosis was performed in seven patients,one patient was received pyeloureteroplasty.No serious complications of blood vessel and ureter were found during perioperative and long-term follow-up.All cases follow-up hitherto have normal renal function and blood pressure.Conclusions Renal autotransplantation can be appropriate for patients with proximal ureteral loss and complex hilar renal artery aneurysms.In addition,it is able to protect renal functions to the most extent and provides a surgical alterative for complex renal diseases.