自家腎移植術の適応とその手術成績 : 腎血管性病変に対する自家腎移植術について

Abstract

腎血管性病変に対する自家腎移植20症例22腎の経験を述べた.Ex vivo surgeryを用いたのは20例中11例であり, 術後, 高血圧は治癒17例, 改善3例と良好な成績を得た.なお, 過去25年間の腎血管性高血圧症例は58例で, 手術的治療をおこなった46例51腎中in situ repairを施行した7例の成績は治癒0, 改善2, 不成功5例であった

Twenty patients with renovascular disease in 22 kidneys were treated surgically by the method of renal autotransplantation at our department during the 13 years from 1970 to 1982. Etiological disorders included 11 cases of fibromuscular dysplasia, 3 cases of atherosclerosis, 3 cases of aortitis syndrome, two cases of renal artery aneurysm and one case of renal artery thrombosis. Age distribution ranged from 13 to 64 years old (average 28.9 years), and male to female ratio was 1 to 3. Ex vivo surgery was carried out in 11 of these 20 cases. Angioplasty in 9 cases, endarterectomy and partial nephrectomy in one case each were performed extracorporeally. Reconstruction of the urinary tract was needed for 14 kidneys in 13 patients, 12 kidneys were treated by UCN, and PU anastomosis was performed in 2 kidneys in 2 patients. Outcome of renal autotransplantation was "cured" in 17 cases and "improved" in 3 cases during follow-up period from 8 months to 13 years. Revision was successful for the postoperative complication such as urine leakage, bladder tamponade, perirenal fluid collection and ileus.