Tawm tswv yim Ntawm Raum Autotransplantation: Ib qho kev xaiv kawg los khaws lub raum tom qab Iatrogenic ureteral raug mob
Dec 23, 2022
Christos Damaskos 1, 2*, Nikolaos Garmpis 2, 3*, Konstantinos Nikolettos 4, Alexandros Patsouras 2, Dimitrios Schizas 5, Anna Garmpi 6, Vasiliki E. Georgakopoulo 7, Athanasios Syllaios 5, Dimitrios Dimitroulis 3
1. Lub Raum Hloov Pauv Hloov Chaw, Laiko General Tsev Kho Mob, Athens, Greece;
2. NS Christmas Laboratory of Experimental Surgery and Surgical Research, Medical School, National thiab Kapodistrian University of Athens, Athens, Greece;
3. Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob Thib Ob, Tsev Kho Mob Laiko General, Tsev Kawm Ntawv Kho Mob, National thiab Kapodistrian University of Athens, Athens, Greece;
4. Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece;
5. Thawj Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob, Laiko General Tsev Kho Mob, Tsev Kawm Ntawv Kho Mob, National thiab Kapodistrian University of Athens, Athens, Greece;
6. Thawj Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob Hauv Tsev, Laiko General Tsev Kho Mob, Tsev Kawm Ntawv Kho Mob, National thiab Kapodistrian University of Athens, Athens, Greece;
7. Department of Pulmonology, Laiko General Tsev Kho Mob, Athens, Greece.
* Kev sib npaug sib npaug.
Hu rau Editor,
Autologous Lub raum Kev hloov pauv(ART) txij li thawj zaug piav nyob rau hauv 1963 los ntawmHardy, tau siv ntau yam (1). Muaj ntau yam laj thawj rau kev hloov pauv xws li iatrogenic ureteral puas, mob raum mob, mob raum tsis tuaj yeem, lossis kab mob renovascular (2, 3). Cov lus qhia txog cov neeg mob tsim nyog rau cov txheej txheem no yog maj mam nce. Txawm li cas los xij, txhua rooj plaub yog qhov tshwj xeeb, thiab kev kho mob yuav tsum yog tus kheej.
ART yog ib txoj kev uas muaj ntau yam teeb meem. Cov no suav nrog kev kis kab mob, kev ua haujlwm tsis ua haujlwm, tso zis tawm, thiab lub raum vein thrombosis (2). Txawm li cas los xij, kev khaws cia raum yog qhov tseem ceeb heev rau cov neeg mob. Nyob rau hauv teb rau rooj plaub ntawmMoulavasib ilisthiab al., kev khaws cia raum yog kev txiav txim siab los ntawm ob tus neeg mob thiab pab pawg kws kho mob ntau yam (4). Tus neeg mob muaj hnub nyoog 41 xyoo, thiab tseem muaj peev xwm xeeb tub. Txawm li cas los xij, nws yog ib lub hnub nyoog siab heev tab sis tsis txwv lub hnub nyoog rau kev yug me nyuam nrog kev muaj peev xwm ua rau muaj teeb meem. Vim li cas thiaj ua haujlwm vim muaj ib lub raum ua haujlwm ntxiv? Thaum lub sij hawm thib ob ntawm cev xeeb tub, glomerular infiltration yog nce ntau dua 40 feem pua ntau zaus (5). Cov kab mob hauv lub raum ntev lossis txawm tias lub raum tsis zoo tuaj yeem pab txhawb qhov tshwm sim ntawm cev xeeb tub cov teeb meem xws li preeclampsia, uas suav nrog albumin-uria thiab arterial hypertension (6). Tsis tas li ntawd, arterial preeclampsia tuaj yeem ua rau lub raum puas tsuaj, los ntawm kev ua kom tsis muaj podocyte, endothelial puas, thiab mob raum raug mob (5). Yog li ntawd, qhov kev nyiam ntawm tus neeg mob rau lub raum preservation, muaj peev xwm muaj siab rau cev xeeb tub nrog rau nws qhov chaw kho mob zoo ua rau kev phais qhov kawg.
Nyem qhov no rau lub raum Heath
Tag nrho cov teeb meem hais saum toj no tuaj yeem tshwm sim thaum cev xeeb tub tom qab hloov lub raum (7). Kev pheej hmoo rau cov teeb meem yog kev tiv thaiv kab mob (kev hloov pauv hloov pauv), niam txiv proteinuria, thiab kub siab (8). Cov cev xeeb tub no cuam tshuam nrog kev pheej hmoo siab ntawm ob qho tib si niam thiab menyuam hauv plab. Mob graft rejection, preeclampsia, cesarian seem, thiab me nyuam yug me nyuam qhov hnyav yog ib qho teeb meem. Nws yuav tsum raug pom tias qhov ua tau ntawm kev poob qis yog me ntsis siab dua hauv thawj 2 xyoo tom qab yug me nyuam, thiab tsis muaj qhov sib txawv ntawm 10 xyoo tom qab yug me nyuam piv rau kev tswj tsis tau (7-9).
Tsuas yog rau lub raum autotransplantation, lwm txoj kev xaiv kuj muaj nyob rau hauv cov neeg mob uas muaj ureteral avulsion. Anastomosis ntawm lub pelvis ntawm lub raum thiab lub ileum yog lub ileal ureter. Nws raug pom zoo nyob rau hauv rooj plaub uas nws raug mob ureter. Txawm li cas los xij, cov kab mob tso zis thiab mob tuaj yeem tshwm sim hauv lub sijhawm tom qab phais (10). Tsis tas li ntawd, cov teeb meem metabolic thiab plab hnyuv kuj yog cov chaw kho mob nquag tom qab hom kev phais no (11). Txawm tias cov ntawv txuas ntxiv cuam tshuam tau raug tshaj tawm hauv cov ntaub ntawv (12).
Buccal mucosa tsuas yog ua lwm txoj kev xaiv rau kev tswj cov kev raug mob ureteral. Lub qhov ncauj mucosa yog yooj yim nkag tau thiab ntub. Grafts yog muab los ntawm ob sab hauv qaib los yog di ncauj. Nws yog cov txheej txheem tshiab, uas yog siv nyob rau hauv ob peb xyoos dhau los. Nws tuaj yeem ua tau raws li kev phais qhib, laparoscopic, lossis neeg hlau pab. Txawm hais tias qhov kev tshaj tawm ua tiav ntawm qhov kev phais no yog siab heev, cov txheej txheem no yuav tsum tau siv ntau dua rau kev ntsuam xyuas zaum kawg (13). Txawm li cas los xij, tsis muaj cov ntaub ntawv hais txog kev ua tiav ntawm qhov kev phais no nyob rau hauv cov neeg mob uas xav tau kev tsim kho lub ureter ntau dua 11 cm (14). Restenosis lossis nruj-tseeb rov tshwm sim kuj tau tshwm sim hauv qee kis (13, 15). Nephrostomy yog lwm txoj hauv kev rau cov kab mob ureteral puas. Nws yog cov txheej txheem minimally invasive uas yooj yim ua. Nws feem ntau yog ua rau cov neeg mob, kom ruaj khovlawv, thiabfeem ntau tsis yog ib qho kev daws teeb meem tas mus li. Tus kab mob no tsawg heev, tsawg dua 0.04 feem pua, thiab cov teeb meem muaj xws li txoj hnyuv perforation los yog los ntshav. Kev siv tshuaj tua kab mob ua ntej kev siv nephrostomy yuav tsum pib (16).
Thaum kawg, nephrectomy yog lwm txoj kev xaiv rau cov neeg mob uas muaj kev puas tsuaj ureteral. Qhov kev txiav txim siab ntawm tus neeg mob thiab qhov nyuaj ntawm kev tsim kho ureter tuaj yeem ua rau laparoscopic nephrectomy qhov kev xaiv tau (17). Tsis tas li ntawd, cov txheej txheem no muaj kev nyab xeeb dua, nrog cov teeb meem tsawg dua, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas muaj lwm yam comorbidities. Ntawm qhov tod tes, tus neeg mob tsuas muaj ib lub raum ua haujlwm xwb.
Ntau yam kev phais muaj nyob rau kev tswj ntawm ureteral avulsion. ART yog ib qho kev cuam tshuam kev kho mob, uas tuaj yeem ua rau muaj txiaj ntsig zoo thiab tsis zoo. Yuav tsum muaj kev paub txog kev kho mob, thiab nws yuav tsum tau siv thaum cov txheej txheem kho mob tau raug txiav txim siab. Yog vim li cas, lub sijhawm, thiab hom kev phais yog qhov tseem ceeb heev rau cov txiaj ntsig ntawm tus neeg mob. Yog li, txhua hom kev tswj hwm tuaj yeem suav tias yog qhov raug thiab tsis raug, nyob ntawm qhov kawg ntawm kev kho mob. ART yog qhov nyuaj.
Cistanche tshuaj yej tuaj yeem txhawb lub raum yang, ntxiv cov ntsiab lus thiab cov ntshav, inhibit qhov tsos ntawm "Yang deficiency" cov tsos mob, thiab tiv thaiv kev poob phaus. Cistanche tshuaj yej tuaj yeem tiv thaiv thiab kho cov kab mob xws li lub raum tsis muaj zog thiab tsis muaj zog hauv cov txiv neej, tsis muaj hnub nyoog emission, ejaculation ntxov ntxov, kev coj khaub ncaws tsis xwm yeem, amenorrhea, thiab infertility hauv cov poj niam. Citrus cinnamon muaj lub koob npe nrov ntawm "suab puam ginseng", thiab nws yog cov tshuaj qib siab tshaj plaws ntawm ntau tshaj 60 hom tshuaj suav tshuaj tonic pom hauv Suav teb. Nws muaj ntau cov amino acids, cysteine, vitamins, thiab minerals. , cavernous lub cev thiab lwm yam kabmob ntawm kev sib deev muaj ib tug zoo tonic nyhuv, lub impotence, ntxov ntxov ejaculation yog txawm ntau tam sim ntawd, ua tiav zoo li ib tug vajtswv. Cistanche tshuaj yej tuaj yeem siv rau lub raum tsis muaj zog, impotence, emission nocturnal, ejaculation ntxov ntxov, mob khaub thuas hauv lub duav thiab hauv caug, thiab cov leeg tsis muaj zog thiab cov pob txha. Rau kev kho mob ntawm impotence vim lub raum tsis txaus, nocturnal emission, ejaculation ntxov ntxov, thiab lwm yam, nws yog ua ke nrog Rehmannia glutinosa, dodder noob, thiab dogwood nqaij. Nws yog qhov tsim nyog rau cov txiv neej uas tsis muaj zog ntawm kev sib deev; cov poj niam uas cev xeeb tub tsis tu ncua, tsis muaj menyuam, loog ntawm cov ceg, lub duav thiab mob hauv caug; cov neeg laus uas muaj lub cev tsis muaj zog, cov neeg mob ntshav siab, thiab cem quav.
REFERENCES
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Sib thamdence
Christos Damaskos, MD, MSc, Ph.D. (Cim Tus sau)
x_damaskos@yahoo.gr
Renal Transplantation Unit, Laiko General Hospital & NS Christmas Laboratory of Experimental Surgery and Surgical Research, Medical School, National thiab Kapodistrian University of Athens; 17 Agiou Thoma Street, Athens, 11527 (Greece)
Nikolaos Garmpis, MD, MSc, PhD
NS Christmas Laboratory of Experimental Surgery and Surgical Research, Medical School, National thiab Kapodistrian University of Athens & Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National thiab Kapodistrian University of Athens, Athens, (Greece)
Kontstantinos Nikolettos MD
Obstetric thiab Gynecologic Clinic, Tsev Kawm Ntawv Kho Mob, Democritus University of Thrace, Alexandroupolis, (Greece)
Alexandros Patsoras MD
NS Christmas Laboratory of Experimental Surgery and Surgical Research, Medical School, National thiab Kapodistrian University of Athens, Athens (Greece)
Dimitrios Schizas, MD, Ph.D., Tus pab xibfwb ntawm Kev phais
Thawj Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob, Laiko General Tsev Kho Mob, Tsev Kawm Ntawv Kho Mob, National thiab Kapodistrian University of Athens, Athens (Greece)
Anna Garmpi, MD
Thawj Department of Propedeutic Internal Medicine, Laiko General Tsev Kho Mob, Tsev Kawm Ntawv Kho Mob, National thiab Kapodistrian University of Athens, Athens (Greece)
Vasiliki E. Georgakopoulo, MD
Department of Pulmonology, Laiko General Tsev Kho Mob, Athens (Greece)
Athanasios Syllaios, MD
Thawj Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob, Laiko General Tsev Kho Mob, Tsev Kawm Ntawv Kho Mob, National thiab Kapodistrian University of Athens, Athens (Greece)
Dimitrios Dimitroulis, MD, MSc, Ph.D., xibfwb ntawm Kev phais
Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob Thib Ob, Tsev Kho Mob Laiko General, Tsev Kawm Ntawv Kho Mob, National thiab Kapodistrian University of Athens, Athens (Tebchaws Greece)
Yog xav paub ntxiv:1595715123@qq.com
