Sacks S A
Urol Clin North Am. 1975 Jun;2(2):381-400.
Autotransplantation of the kidney has proved to be an extremely valuable surgical alternative for the treatment of renovascular hypertension. The modern operation is founded in landmark surgical experiments performed during the early years of this century. Despite the relative technical simplicity and considerable potential application of renal autotransplantation, the operation was not employed for at least a decade following the more uncertain initial clinical adventures in renal allotransplantation. Since its inception, however, the successful use of renal autotransplantation for renovascular hypertension has been well documented in a relatively small but impressive series of clinical situations. Renal autotransplantation in the surgical management of renovascular hypertension appears to afford many technical advantages vis-à-vis in situ renal revascularization including the option to perform meticulous ex vivo reconstructive surgery. The need to interrupt the renal circulation during renal autotransplantation and the possibility that the ischemic operative interval might result in renal cellular damage, has been a deterrent to greater consideration of this surgical alternative. Cold perfusion of the ischemic kidney has been regarded as "inherently" necessary in order to prevent intravascular coagulation and to protect the kidney through the use of hypothermia until the circulation is re-established. A wide variety of perfusates and methods of perfusion have been successfully employed for these purposes. A new perfusate has been formulated which is intended to help prevent the rapid and profound changes in the amounts of distribution of intracellular electrolytes and water which are known to occur when the kidney is deprived of its circulation. This solution appears to be effective in preventing significant damage in ischemic canine kidneys during at least three hours of normothermic exposure, and at least five hours of ambiothermic exposure following a single initial cold perfusion. The various perfusates and methods of renal perfusion for clinical and experimental renal autotransplantation and ex vivo renal surgery are herein compared and contrasted with regard to their proposed mechanisms of action, apparent effectiveness, and simplicity of application.
肾自体移植已被证明是治疗肾血管性高血压的一种极其有价值的外科替代方法。现代手术基于本世纪初进行的具有里程碑意义的外科实验。尽管肾自体移植在技术上相对简单且有相当大的潜在应用价值，但在肾同种异体移植最初那些不太确定的临床尝试之后，该手术至少十年未被采用。然而，自其诞生以来，肾自体移植成功用于肾血管性高血压的情况在一系列相对较少但令人印象深刻的临床病例中已有充分记录。在肾血管性高血压的外科治疗中，肾自体移植相对于原位肾血管重建似乎具有许多技术优势，包括能够进行细致的体外重建手术。肾自体移植过程中需要中断肾循环，以及缺血手术间期可能导致肾细胞损伤，这一直是阻碍更多考虑这种外科替代方法的因素。为了防止血管内凝血并通过低温保护肾脏直至循环恢复，缺血肾脏的冷灌注被视为“内在”必要。为了这些目的，已经成功采用了各种各样的灌注液和灌注方法。一种新的灌注液已经配制出来，旨在帮助防止当肾脏失去循环时已知会发生的细胞内电解质和水分分布量的快速而深刻的变化。这种溶液似乎在防止正常体温下至少三小时以及单次初始冷灌注后变温下至少五小时的缺血犬肾严重损伤方面是有效的。本文就临床和实验性肾自体移植及体外肾手术中各种肾灌注液和灌注方法的作用机制、明显效果及应用简便性进行了比较和对比。
