自家腎移植の腫瘍および結石への適応

Abstract

Renal preservation and cure of bilateral occurrence of renal tumors or stones as well as occurrence in solitary kidney put all urologists on the thorns of dilemma. Application of extracorporeal surgery resulting in autotransplantation of the kidney for such complicated cases seems useful. Case 1 was a bilateral renal Wilms' tumors in a 17-month-old boy, case 2 and 3 were undiagnosed tumors in renal pelvis and ureter. Extracorporeal surgery enables an accurate partial nephrectomy and yet helps to avoid not only the dissemination of tumor cells, but also undesired nephrectomy in case of benign origin. On the contrary, bilateral nephrectomy followed by dialysis or homo-transplantation will result in an immunosuppressive state and the radicality may only be temporary. Besides, the 5-year survival of dialysis therapy is in the range of 60-65%. Thus the indication of autotransplantation was signified in the tumor situation of case 1. For the 2nd and 3rd cases, this method seems to be the best in satisfying the dilemma in discussion. Likewise, the complicated renal calculi could be completely removed without further deterioration of renal function if they were extracorporeally treated and autotransplanted. We proved that 83% of the difficult stones can be completely removed under hypothermia in situ. For application of autotransplantation to the calculous disease, we feel observation of contraindication is essential for better results at this stage.