Isolated renal artery angioplasty and autologous kidney transplantation

In 1962, Hardy first succeeded in transplanting a kidney with severe ureteral injury and ureteral transplantation into the ipsilateral axilla. The next year Woodruff was about to use autologous kidney transplantation for the treatment of renal vascular hypertension. In 1967, Ota reported that after renal artery disease was performed in vitro, microsurgical arterial angioplasty was performed, and autologous renal transplantation was performed to achieve the desired effect, so that the technique is more commonly applied to the kidney. Treatment of vascular hypertension. In 1970, Belzer designed a renal extracorporeal circulation device and used it for continuous cold perfusion kidney test in order to have sufficient time and environment to repair the renal artery branch disease of the animal. After completion, the autologous kidney transplantation was successful. For the first time, Corman applied the above animal experiment method to the clinic. In the 1970s and 1980s, due to the use of a single cold-filled special intracellular electrolyte solution, the cell function of the isolated kidney was effectively protected, making the operation of this operation easier, safer and more reliable. Apply to the treatment of renal vascular hypertension. Especially for some branch lesions that cannot be repaired in situ or for the treatment of renal artery lesions in children, the superiority of this technique can be better demonstrated. After the mid-1970s, hospitals across China also reported the use of autologous kidney transplantation for the treatment of renal vascular hypertension. Treatment of diseases: kidney tumor kidney cancer Indication Isolated renal arterial and autologous kidney transplantation are suitable for: In the lesions of the main renal artery, various renal angioplasty can be performed in situ in the kidney. However, renal artery muscle fiber proliferation has a wide range of lesions, often invading the first branch or even the second branch. Where the lesion vessels are beyond the renal artery trunk and the blood vessel diameter is less than 3 mm, it is impossible to perform renal artery formation in situ. Surgery. However, if ex vivo kidney surgery is used, the renal sinus will be stripped under direct vision without blood flow, and the second grade branch of the renal artery can be clearly revealed outside the renal parenchyma, such as the application of microsurgical techniques to complete the complex The arterial angioplasty procedure will not cause any difficulty. In recent years, the isolated renal surgery for the treatment of renal vascular hypertension reported in foreign countries is mostly used for renal artery reconstruction of renal artery branch disease. Renal vascular hypertension in children, in the past when the use of in situ renal angioplasty failed, the disease of branch disease can not be operated, all nephrectomy, since the use of excised kidney surgery technology, the kidneys are cured The possibility of blood pressure. Abdominal aortic lesions are extensive, and it is not suitable for the main-renal artery bypass grafting. As long as the radial artery is intact, it is the indication for this operation. The first failure of renal angioplasty, local connective tissue hyperplasia, adhesions, in situ can not be stripped clearly to obtain a good exposure, can be tested for autologous renal transplantation of isolated renal arteries, more chances of success. Renal autograft is the follow-up method of excised kidney surgery and is the final step of this technique. At present, autologous kidney transplantation is not the only way to treat renal vascular hypertension. Surgical procedure 1. Incision and exposure Under general anesthesia, a straight abdominal incision enters the abdominal cavity and the retroperitoneal space is widely exposed. The kidney and ureter are exposed, and the incision is extended to expose the ipsilateral axillary fossa and the iliac vessels. In the case of free kidney and upper ureter, in order to protect the collateral circulation and blood supply to the ureter that has been established in the kidney, it should be peeled off together with the intact outer membrane and fat. 2. Perfusion of the kidney Before the renal vascular detachment, the inner environment of the kidney must be in the best stable state. The commonly used method is: conventionally input low molecular weight dextran 500 ~ 1000ml, mannitol 25g, furosemide (furosemide) 40mg, hydrocortisone 250mg. After the above treatments were completed, the renal pedicle was gently peeled off, the kidneys were excised, and the upper segment of the ureter that was not severed was removed from the body, and cold perfusion was immediately performed through the renal artery. The perfusate is preferably a hypertonic intracellular electrolyte solution at 4-8 ° C. Quantitative heparin is added and instilled by gravity until the renal vein effluent is clear and the kidney is pale. 3. Anastomotic vessels After the perfusion, the renal artery was dissected and the stenotic lesion was removed. If the lesion is resected, there is still a section of the trunk that can be formed. The autologous saphenous vein or splenic artery can be used for free transplantation and endoscopic anastomosis of the internal iliac artery. End-to-side anastomosis can also be performed on the common iliac artery. The renal vein was anastomosed to the external iliac vein, and the uncut ureter was placed in the retroperitoneal space, and drainage was not affected. If the renal artery disease has affected the branch, the renal sinus is peeled off without blood flow, and the branch of the artery is completely separated, and the lesion portion of the artery is completely removed, and the 2 branches are sewn into a lumen tube. The defected arterial segment was filled with autologous vascular free grafting and then anastomosed with the end of the internal iliac artery. The renal vein and the external iliac vein were anastomosed. In vitro renal cold infusion has also been used in vitro renal circulation device, which is considered to be more effective, but it is actually no different from a single cold perfusion. The warm ischemia time and cold ischemia time of this operation are quite short. A special device. In the operation of the operation, there are also those who have broken the ureter. For example, if the kidney is not removed and moved to another operating table, and another group of surgeons perform angioplasty, it is not necessary to cut off, so as to avoid complications such as ureteral urinary fistula.

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