In vitro partial nephrectomy and autologous kidney transplantation

In vitro partial nephrectomy Autologous renal transplantation is indicated for large tumors in the middle of the kidney or in the middle of the kidney. The advantage is that the exposure is sufficient, the surgery field has no blood, and the fine surgical operation can be performed for a long time without causing renal ischemic damage, and the renal parenchyma is retained to the utmost. Curing disease: Indication The surgery for kidney tumor retention nephron is adapted to 1 isolated kidney. 2 side of the kidney cancer and the contralateral kidney has no function or has been removed, or the contralateral kidney has diseases that may threaten its function such as stones, inflammation and congenital diseases, renal arteriosclerosis and the like. 3 bilateral renal cell carcinoma, the smaller side of the tumor was partially resected, and the larger side was treated with radical nephrectomy. Bilateral single renal tumors were all <3 cm in diameter, and bilateral bilateral partial resection was feasible. 4 unilateral single malignant renal tumor, diameter <3cm, the position is relatively shallow, and the contralateral renal function is normal. Among them, 1 to 3 is called impulsive partial nephrectomy, and 4 is called selective partial nephrectomy. Contraindications 1, except for very superficial tumors, renal angiography should be performed before surgery to understand the movement of the renal artery. 2. Understand the condition of the contralateral kidney. 3, large tumor in the middle of the kidney, the location is deeper, pyelography to understand the distribution of renal pelvic drainage system. 4. Prepare aseptic crushed ice before surgery. 5. Give enough fluid before surgery to ensure effective intraoperative renal perfusion. Surgical procedure 1. The midline incision of the abdomen enters the abdominal cavity and exposes the kidneys. 2. Fully free the kidney outside the Gerota fascia, free the kidneys, veins and ureters, pay attention to protect the ureteral blood supply. Quickly instill 100-150ml mannitol, ligature 5~10min, cut off the kidneys and veins, ligature the ureter near the iliac vessels, and immediately place the kidneys in the pot containing 0~4 °C kidney preservation solution, through the renal artery The intubation was perfused with an intracellular liquid kidney preservation solution at 0 to 4 ° C until the kidneys were evenly pale. 3. Anatomize the renal artery and vein, remove the adipose tissue around the kidney and the renal arteriovenous, and ligature and cut off the extrarenal blood vessel branch into and out of the renal arteries and veins. Exfoliate excess adipose tissue around the ureter, retaining the renal pelvis and the adipose tissue between the upper ureter and the kidney. 4. Dissect the renal segment blood vessels in the renal hilum, and inject the methylene blue solution to display the supply area of the artery. The blood vessels that completely supply the renal tumor are all ligated. Some blood vessels supplying kidney tumors should be marked. After the tumor is resected, the branches of the tumor-bearing area are examined by methylene blue injection for ligation. The renal capsule and renal parenchyma were dissected 1 to 2 cm along the edge of the tumor, and the renal parenchyma was removed from the middle of the kidney if necessary. The blood vessels visible on the wound were ligated with a 4-0 absorbable line, and the renal collecting system was closed. The kidney preservation solution was alternately perfused through the renal artery and the renal vein with 0 to 4 ° C, and the liquid outflow was sutured on the wound surface, and a small amount of exudative liquid leakage could not be treated. 5. Directly on the kidney wound, sutured with 2-0 absorbable lines. 6. Enter the extraperitoneal space through the "L" shaped incision in the right lower abdomen, expose the iliac vessels, place the kidney in the armpit, and perform autologous kidney transplantation.

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