116例胰肾联合移植术中输尿管端-端吻合方式的探讨  

Ureteral end-torend anastomosis during simultancous pancreas kidney transplantation at a single center:a report of 116 cases

作　　者：李立[1] 陈正[1] 马俊杰[1] 张磊[1] 李光辉[1] 方佳丽[1] 赖兴强[1] 潘光辉[1] 石炳毅[2] Li li;Chen Zheng;Ma Junjie;Zhang Lei;Li Guanghui;Fang Jiali;Lai Xingqiang;Pan Gruanghu;Shi Bingyi(Organ Transplant Center,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China;Organ Transplantation Research Institute.The 8th Medical Center of Chinese PLA General Hospital,Beijing 100091,China)

机构地区：[1]广州医科大学附属第二医院器官移植中心,510260 [2]解放军总医院第八医学中心全军器官移植研究所,北京100091

出　　处：《中华器官移植杂志》2020年第9期522-525,共4页Chinese Journal of Organ Transplantation

基　　金：广州市临床重大技术项目。

摘　　要：目的总结116例胰肾联合移植术中输尿管处理经验,探讨供肾输尿管与受者输尿管端端吻合的安全性和有效性。方法广州医科大学附属第二医院2016年1月至2019年12月共成功完成116例胰肾联合移植手术,术中均采用供肾输尿管与受者输尿管端端吻合,留置F6输尿管支架管,术后1~3个月拔除。术后追踪观察移植肾输尿管并发症和受者自体肾脏变化情况。结果116例受者中5例发生输尿管相关并发症。其中1例尿瘘,经保守治疗痊愈;4例输尿管不全梗阻,均采用输尿管镜逆行腔内治疗,1例治愈,余3例定期更换输尿管支架管。116例中有111例胰肾联合移植供肾的对侧肾行单纯肾移植,对比两种手术的术后输尿管相关并发症发生率差异无统计学意义(P=0.235)。116例胰肾联合移植受者中,共追踪到89例受者的术前和术后自体肾形态变化情况,其中术前有尿者73例,术前无尿者16例,术后共有85例受者出现移植肾同侧的自体肾轻度积液。术前有尿和术前无尿受者术后自体肾积水的发生率差异无统计学意义(P=0.554)。术后自体肾积水不需要特殊治疗。结论胰肾联合移植术中输尿管端端吻合安全有效,可减少手术操作的难度,降低术后并发症,避免发生输尿管梗阻后再次开放手术等。Objective To summarize the managernent experience of ureter during simultaneous pancreas and kidney(SPK)transplantation and explore the safety and efficacy of end to end anastomosis of donort/recipienter ureter,Methods From January 2016 to Dcermber 2019,116 cases of SPK were sucessfully completed.During operation,ureter was anastomosed end-to-end.A F6 ureteral stent was retained in ureter and removed after 1~3 months.Ureteral complications and changes of autogenous kidney were recorded.Results There were 5 cases of ureteral related complications.One case of urinary fistula was cured conservatively while 4 cases of incomplete ureteral obstruction were managed by intralurminal ureteroscopy.One case was cured and 3 cases had regular replacement of ureteral stent.A total of 89 SPK patients were reexamined by abdominal computed tomography(CT)and 85 cases developed right autogenous hydronephrosis.No significant difference existed in the incidence of postoperative autogenous hydronephrosis between patients with preoperative urine and those without preoperative urine(P=0.554)。No special treatment was needed for postoperative autogenous hydronephrosis.Conclusions Ureteral end-to-end anastomosis is both safe and ffective during SPK transplantation.It offers the advantages of lowering operative complexity and minimizing postoperative complications.After ureteral obstruction,it is also convenient to employ endoscopy and avoid reoperation due to its similar natural lumen.

关 键 词：胰肾联合移植 输尿管输尿管吻合术 并发症 肾积水 

分 类 号：R657.5[医药卫生—外科学] R699.2[医药卫生—临床医学]