Tran Geraldine, Ramaswamy Krishna, Chi Thomas, Meng Maxwell, Freise Christopher, Stoller Marshall L
School of Medicine (GT), Department of Urology (KR, TC, MM, MLS) and Department of Surgery (CF), University of California, San Francisco, San Francisco, California.
J Urol. 2015 Sep;194(3):738-743. doi: 10.1016/j.juro.2015.03.089. Epub 2015 Mar 20.
Laparoscopic nephrectomy with autotransplantation is a viable option when renal preservation is required or ureteral reconstruction is impossible. In this study we report on our long-term experience with laparoscopic nephrectomy with autotransplantation.
A retrospective review of data from all patients who underwent laparoscopic nephrectomy with autotransplantation since 2000 revealed data for 52 of 59 patients after study exclusions. Indications for laparoscopic nephrectomy with autotransplantation included ureteral stricture disease (41), renal malignancy (7), ptotic kidney (1), chronic flank pain (1), renal artery aneurysm (1) and renovascular hypertension (1). Followup included ultrasonography, nuclear renography and computerized tomography. Complications analyzed were Clavien-Dindo grade III or higher.
A total of 52 patients (30 women, 57.6%) underwent laparoscopic nephrectomy with autotransplantation at a median age of 48 years (range 12 to 76). At a median followup of 73.5 months 47 patients (90.3%) had long-term function of the autotransplanted renal unit including 3 of 4 (75%) solitary kidneys. There were 5 patients (9.7%) who experienced renal unit failure at a median of 15 months. Of these patients 3 required nephrectomy of autotransplant unit secondary to renal vein thrombosis (1 day), pseudoaneurysm (15 months) and chronic pain (48 months). Overall 4 patients had early complications and 8 had late complications. In the tumor group 4 patients had disease progression and all are alive.
Laparoscopic nephrectomy with autotransplantation is an excellent long-term surgical option (greater than 90% success rate with longer than 6-year median followup) for complex ureteral and renal conditions that necessitate preservation of renal parenchyma. However, tumor progression is possible after ex vivo tumor excision. Therefore, careful patient selection and followup are mandatory. This report supports the safety, efficacy and durability of laparoscopic nephrectomy with autotransplantation in experienced hands.
当需要保留肾脏或无法进行输尿管重建时，腹腔镜肾切除术联合自体肾移植是一种可行的选择。在本研究中，我们报告了我们在腹腔镜肾切除术联合自体肾移植方面的长期经验。
对2000年以来所有接受腹腔镜肾切除术联合自体肾移植患者的数据进行回顾性分析，排除研究对象后得到59例患者中的52例数据。腹腔镜肾切除术联合自体肾移植的适应证包括输尿管狭窄疾病（41例）、肾恶性肿瘤（7例）、肾下垂（1例）、慢性胁腹痛（1例）、肾动脉动脉瘤（1例）和肾血管性高血压（1例）。随访包括超声检查、核素肾显像和计算机断层扫描。分析的并发症为Clavien-DindoⅢ级或更高等级。
共有52例患者（30例女性，占57.6%）接受了腹腔镜肾切除术联合自体肾移植，中位年龄为48岁（范围12至76岁）。中位随访73.5个月时，47例患者（90.3%）的自体移植肾单位具有长期功能，包括4例单肾中的3例（75%）。有5例患者（9.7%）在中位时间15个月时出现肾单位功能衰竭。在这些患者中，3例因肾静脉血栓形成（1天）、假性动脉瘤（15个月）和慢性疼痛（48个月）而需要切除自体移植肾单位。总体而言，4例患者有早期并发症，8例有晚期并发症。在肿瘤组中，4例患者出现疾病进展，所有患者均存活。
对于需要保留肾实质的复杂输尿管和肾脏疾病，腹腔镜肾切除术联合自体肾移植是一种出色的长期手术选择（中位随访超过6年，成功率超过90%）。然而，体外肿瘤切除后肿瘤有可能进展。因此，必须仔细选择患者并进行随访。本报告支持在经验丰富的医生手中，腹腔镜肾切除术联合自体肾移植的安全性、有效性和持久性。
