Teng H S, Hardie I R, Samaratunga M L, Gardiner R A
Department of Urology, Royal Brisbane Hospital, Queensland, Australia.
Br J Urol. 1998 Dec;82(6):877-81. doi: 10.1046/j.1464-410x.1998.00863.x.
To determine whether Dexon mesh, closely applied to the kidney, provides purchase for sutures to permit bladder/parenchymal apposition on autotransplantation and that, if this line of apposition were some distance from but surrounding renal papillae, urothelium would proliferate to cover exposed parenchyma to form a widely patent lumen; this should facilitate removal of the whole of an upper tract collecting system, retaining renal parenchyma alone.
To test this possibility and explore the practicability of the concept, nine dogs underwent bilateral nephrectomy followed by unilateral autotransplantation: the other kidney was discarded. Because the canine renal pelvis is intrarenal, the ureter was stretched maximally before passing fine scissors into the renal hilum to transect the collecting system as close to the kidney as possible in six of the nine dogs. In the remaining three dogs, partial nephrectomy was performed with division of the calyceal necks under vision. Thinned bladder wall was sutured to Dexon mesh some distance from the collecting tubules; omentum was applied to the suture line.
Three dogs were killed prematurely at < 2 weeks because of perioperative complications. Four were killed at 2, 4, 5 and 8 weeks and two at 12 months. Dexon mesh proved to be an effective anchoring fabric, providing close apposition of bladder wall and parenchyma. There was no adhesion of the kidney to peritoneal contents. Urothelial proliferation to cover exposed parenchyma occurred early and by 12 months, a thin stroma was interposed between parenchyma and epithelium. The kidney was preserved in all but one removed electively, this dog having both cystitis and pyelonephritis at 12 months.
This study showed that autotransplantation of a kidney after removal of its collecting system and advancement of thinned bladder wall to renal parenchyma is practicable, with regenerated urothelium bridging the deficiency by covering exposed parenchyma, to create a widely patent lumen.
确定紧密贴合肾脏的 Dexon 网片是否能为缝线提供附着点，以便在自体移植时实现膀胱/实质对合，并且，如果该对合线距肾乳头有一定距离但围绕肾乳头，尿路上皮是否会增殖以覆盖暴露的实质，从而形成一个广泛通畅的管腔；这应有助于切除整个上尿路集合系统，仅保留肾实质。
为检验这种可能性并探索该概念的实用性，对 9 只狗进行双侧肾切除，随后进行单侧自体移植：另一侧肾脏被丢弃。由于犬肾盂位于肾内，在 9 只狗中的 6 只中，在将精细剪刀插入肾门之前，尽可能最大限度地拉伸输尿管，以在尽可能靠近肾脏的位置横断集合系统。在其余 3 只狗中，在直视下进行部分肾切除术并切断肾盏颈部。将变薄的膀胱壁缝合到距集合小管一定距离的 Dexon 网片上；将网膜应用于缝合线。
3 只狗因围手术期并发症在 < 2 周时过早死亡。4 只在 2、4、5 和 8 周时被处死，2 只在 12 个月时被处死。Dexon 网片被证明是一种有效的锚定织物，可实现膀胱壁与实质的紧密对合。肾脏与腹膜内容物无粘连。尿路上皮早期即增殖以覆盖暴露的实质，到 12 个月时，实质与上皮之间插入了一层薄的间质。除一只因 12 个月时患有膀胱炎和肾盂肾炎而被选择性切除外，其余所有肾脏均得以保留。
本研究表明，在切除肾脏的集合系统并将变薄的膀胱壁推进至肾实质后进行肾脏自体移植是可行的，再生的尿路上皮通过覆盖暴露的实质来弥补缺损，从而形成一个广泛通畅的管腔。
