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目的:探讨原位肾移植的手术适应证、手术技巧及临床效果。方法:对5例临床同种异体原位肾移植受者进行回顾性分析,其中男3例,女2例,年龄28～55岁,平均45岁,多囊肾1例,三次肾移植2例,二次肾移植髂血管粥样硬化2例,均先行左肾切除,再行原位肾移植,尿路重建采用肾盂-肾盂端端吻合,术后常规三联免疫抑制治疗。结果:手术经过均顺利,术后2例再次移植受者发生移植肾功能延迟恢复(DGF)。术后1月平均血清肌酐(SCr)124μmol/L。术后随访6月～7年均带肾存活,4例受者移植肾肾功能正常,1例受者术后7年出现慢性移植肾肾病,SCr波动于340～462μmol/L。结论:原位肾移植对于第二、三次肾移植,双侧髂血管条件不好的受者,原位肾移植能达到良好的治疗效果。
Objective: To investigate the surgical indications, surgical techniques and clinical effects of orthotopic kidney transplantation. Methods: Retrospective analysis of 5 cases of clinical allograft orthotopic renal transplantation recipients, including 3 males and 2 females, aged 28-55 years (average 45 years old), 1 case of polycystic kidney disease, 2 cases of three kidney transplantation , Two cases of iliac vascular atherosclerosis secondary renal transplantation, all first left nephrectomy, then the orthotopic kidney transplantation, urinary tract reconstruction with renal pelvis - renal pelvis end anastomosis, postoperative conventional triple immunosuppressive therapy. Results: All patients underwent successful operation. Delayed graft recovery (DGF) occurred in 2 recipients after transplantation. The mean postoperative serum creatinine (SCr) was 124μmol / L in January. Survival was followed up for 6 months to 7 years with renal survival, 4 patients with renal transplant recipients with normal function, 1 patient with chronic allograft nephropathy 7 years after surgery, SCr fluctuations in 340 ~ 462μmol / L. Conclusion: orthotopic kidney transplantation can achieve good therapeutic effect on orthotopic kidney transplantation in the second and third kidney transplant recipients with poor bilateral iliac vascular conditions.