膀胱黏膜下隧道加膀胱黏膜穿通套入式输尿管膀胱吻合在肾移植中的应用  

Application of tunnel and penetrating ureteroneocystomy in kidney transplantation

作　　者：孟安启[1] 于立新[1] 李咏梅[2] 李小庭 杜传福[1] 周保成[4] 

机构地区：[1]南方医科大学南方医院器官移植科,广州510515 [2]中山大学附属第三医院儿科 [3]解放军第四五八医院肾移植科 [4]解放军第四七七医院泌尿外科

出　　处：《中华器官移植杂志》2007年第5期281-283,共3页Chinese Journal of Organ Transplantation

摘　　要：目的探讨膀胱黏膜下隧道加膀胱黏膜穿通套入式输尿管膀胱吻合法的临床效果。方法42例肾移植采用膀胱黏膜下隧道加膀胱黏膜穿通套入式输尿管膀胱吻合法行移植肾输尿管与受者膀胱的吻合,游离与移植肾同侧的膀胱外侧顶部,用血管钳在膀胱浆肌层与黏膜间钝性分离一长约1cm的隧道,修剪成卵圆形的输尿管残端从隧道穿过,再通过粘膜上钝性穿通的小孔进入膀胱,在输尿管进入隧道处及进入膀胱处,将输尿管非血管系膜侧与膀胱壁各缝合2～3针固定。结果42例的输尿管吻合手术耗时为5～8min。术后随访3个月至5年,除1例因排斥反应出现输尿管坏死,1例术后早期因输尿管残端止血不彻底致血块堵塞导尿管而引发漏尿外,其余患者均未发生手术相关并发症,无尿液返流。结论膀胱黏膜下隧道加膀胱黏膜穿通套入式输尿管膀胱吻合法操作简单,耗时短,并发症少,安全可靠,并能有效防止尿液返流。Objective To investigate the new method of ureter bladder anastomosis in renal transplantation. Methods The ureter was pulled into bladder for 1.2 cm through tunnel at the lateral- top of bladder wall,and the ureter fixed on the bladder wall by 2-3 acus with catgut suture. Results Forty of 42 patients had no complications,and recovered very well,except for 1 cases of necrosis caused by acute rejection and 1 case on urine leakage caused by catheter obstruction from blood clot. Conclusion This method is simple,easy to operate,safe and reliable with less complications.

关 键 词：肾移植 吻合术 外科 膀胱 输尿管 

分 类 号：R699[医药卫生—泌尿科学]