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) 124 μmol/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 ～462 μmol/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 study the orthotopic transplantation ( ORT) of the surgical indications, surgical technique and clinical results. Methodology: Five cases of ORT were retrospectively analyzed. They were 3 males and 2 females with a mean of age 45 years old ranged from 28 to 55. They included one of polycystic kidney, 2 cases of third renal transplantation, and 2 cases of second kidney transplantation due to iliac atherosclerosis, were first removed left kidney, then ORT were performed. Urinary tract reconstruction was used the renal pelvis-pelvis anastomosis. All patients received triple combined immunosuppressive protocols after surgery. Results; The operation was successful and postoperative rehabilitation was satisfactory. Two cases of renal retransplantation had delayed graft dysfunction ( DGF) after renal transplantation. The average levels of serum creatinine ( SCr) one month postoperative were 124 u,mol/L. The patients were followed up for 6 months to 7 years. The renal function of the graft was normal in 4 patients. One patient presented an episode of chronic allograft nephropathy with a high SCr level of the 340 ~ 462 |j,mol/L after 7 years. Conclusion; ORT is an excellent option in patients with co-morbidity increased for atherosclerosis and that cannot be placed in the iliac fossaes.
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