摘要
目的 :进一步了解和掌握移植肾输尿管梗阻开放性手术治疗的方法及其优劣。方法 :移植并随访患者 12 31例 ,发生各种原因的输尿管梗阻 5 8例 ,有 5 1例为经开放性手术重建尿路 ,其中移植肾输尿管再植入膀胱 14例 ,移植肾输尿管 自体输尿管吻合 4例 ,移植肾盂 膀胱瓣输尿管成形 (Boariflop)后吻合 2 8例 ,移植肾盂 自体输尿管吻合 5例。结果 :术后早期梗阻均完全缓解 ,随访 1年各种泌尿系并发症复发率 2 1.6 % (11/ 5 1) ,其中5例再次手术 ,3例缓解 ,2例失败 ;另 6例保守治疗移植肾功能稳定 ,效果满意。结论 :①开放性尿路重建是一种直接有效的方法 ;②移植后早期的输尿管梗阻应尽早手术 ,后期进行性加重的梗阻需要择期手术 ,肾功能异常者活检是必要的 ;③各种术式都复发不同的泌尿系并发症 ,以移植肾输尿管再植入膀胱复发率较低 (14 .2 % ) ,肾盂与自体输尿管吻合复发率较高 (4 0 .0 % ) ,肾盂与膀胱吻合反流较多见。④每一种术式都有各自的适应证 ,了解各种术式的优劣 ,合理应用 。
Purpose:The urologic complications of renal transplantation are relatively uncommon, the quoted incidence ranges from 2 to 10%. The obstruction of transplant ureter may occur at the most frequency in all of urologic complications and at any stage posttransplant. It is necessary to know the principles of open surgical management: how and when to re establish ureter.Methods:58 cases had obstruction of transplant ureter within 12 months posttransplantation in 1231 patients received renal transplants from Jul. 1994 to Apr. 2001, with modified extravesical ureteroneocystostomy. 46 cases of them were attempted a retrograde pyelogrom and the insertion of a Double j (D J) stent prior to re operation and only one successed. 51 patients in all patients with ureteric obstruction underwent open surgical management to re establish ureter with D J catheter as stent for 12 16 weeks, respectively by re uerteroneocystostomy in 14 cases, ipsilateral native uerterotransplant ureterostomy in 4 cases, native ureterotransplant pyelostomy in 5 cases, and transplant vesicopyelostomy by the creation of a Boari flap in 28 cases.Results:All of 51 patients were resolved the obstructions with the exception of 2 cases with ureteric leakage in early period after re operation, and 9 cases had recurrent urologic complications in late period till one year postoperatively, including ureteric stricture in 3 cases, stones in 1 case, blood clot in 1 case, vesicoureteric reflux in 4 cases till one year. 5 of them with recurrent urologic complications, including 3 cases with re strictured ureter, one case with stones and one with blood clot in uerter, were re performed the vesicopyelostomy by Boari flap, 3 cases obtained stable renal function and 2 failed, other 6 cases (2 with leakage and 4 with reflux) were cured with non operative treatment and normal transplant function. The different reconstruction fashions possessed different recurrence of urologic complications, respectively with re ureteroneocystostomy in 14.2%, ipsilateral native ureterotransplant ureterostomy in 25.0 %, native ureterotransplant pyelostomy in 40.0 %, and transplant vesicopyelostomy by Boari flap in 21.4 %, but no statistically significant.Conclusions:1.Open surgical management of transplant ureter is a direct and effective method, especially a retrograde pyelogrom and the insertion of a D J stent always are technically more difficult in our modified extravesical ureteroneocystostomy. 2.The obstruction occurred in early stage posttransplantation should be resolved and/or re established the ureter as quickly as possible, in late stage, should be assessed according to degree and progress of the obstruction and histopathology of transplant biopsy, to decide a operation or not. 3. There was not significantly different recurrence of urologic complications among the four fashions, re ureteroneocystostomy with the lowest recurrence, transplant vesicopyelostomy with more vesicoureteric reflux, native uerterotransplant ureterostomy with 25% of ureteric re stenosis, and native ureterotransplant pyelostomy with higher recurrence.
出处
《临床泌尿外科杂志》
2003年第9期540-542,共3页
Journal of Clinical Urology
