供、受者输尿管采取端端吻合的同种肾移植五例  

End-to-end ureteroureteral anastomosis for renal allotransplantation recipients

作　　者：郭时英[1] 邱实[1] 杨宏伟[1] 刘龙[1] 向军[1] 

机构地区：[1]沈阳军区总医院泌尿外科,110016

出　　处：《中华器官移植杂志》2008年第1期16-17,共2页Chinese Journal of Organ Transplantation

摘　　要：目的总结肾移植中供、受者输尿管端端吻合的经验，以提高供肾的利用率。方法5例供肾，3例采取原位灌注肝、肾联合整块切取，2例采取双侧肾脏整块切取，所获供肾输尿管长度为1．8～3．2cm，平均为2．8cm。供肾移植于右侧髂窝，将受者自身的右侧输尿管在髂血管近心侧上方约2．0cm的高度切断，近肾端输尿管结扎，其肾脏旷置，远端输尿管断端与移植肾输尿管行端端吻合。4例放置输尿管内支架管，术后3个月时拔除。结果4例术后1周内、1例术后2周内肾功能恢复正常。术后随访时间平均为6个月，无一例出现旷置肾区胀痛和不适，B型超声波检查未发现旷置肾积水，输尿管吻合处无尿漏。患者均出现不同程度的镜下血尿，拔除输尿管内支架管后血尿消失。结论在供肾输尿管过短的情况下，供、受者输尿管端端吻合是一种可以选择的术式，但取肾时仍应注意保护输尿管，从源头上避免输尿管过短。Objective To summarize the experience of end-to-end ureteral anastomosis of the donor and recipient for renal allotransplantation in order to increase the utilization rate of donor kidney. Methods Among 5 donor kidneys, 3 were obtained by in situ perfusion resection en bloc with liver, and 2 by en bloc bilateral kidney resection. The length of ureter of donor kidney ranged from 1. 8 cm to 3.2 cm （mean 2. 8 cm）. The donor kidney was transplanted into the right iliac fossa. The right ureter of the recipient was cut off at the height of 2. 0 cm above iliac vessels proximal to heart. The end of ureter near kidney was ligated, and kidney was ignored. The far end cut of ureter was anastomosed with the ureter of transplanted kidney. The holders were put into the ureter of 4 patients and extracted three months after operation. Results Renal function in 4 patients recovered within one week after operation, and one patient within two week after operation. During a postoperative followup of 6 months averagely, No patient had discomfort and ache at the region of the ignored kidney. No dropsy was found in the ignored kidney by B-ultrasound. There was no urine at the anastomosis of ureter. Microscopic haematuria to varying degrees occurred in all patients and disappeared when holders were removed from ureter. Conclusion End-to-end ureteral anastomosis of the donors and recipients is an optional way of operation when ureter of donor kidney is too short. But we should pay attention to protect ureter from being too short when we get kidney.

关 键 词：肾移植 吻合术 外科 输尿管 

分 类 号：R699[医药卫生—泌尿科学]