CAJ | 학술논문

目的回顾性分析采用自体输尿管重建尿路技术用于治疗肾移植输尿管并发症的效果和经验.方法将采用自体输尿管重建尿路的26例肾移植受者纳入研究,其中男性18例,女性8例,受者年龄为13～55岁.26例移植后输尿管并发症,其中供肾肾盂输尿管高位损伤者3例,于移植术中行供肾肾盂或输尿管与自体原输尿管吻合;复杂型尿瘘者8例,行自体原输尿管与移植肾盂成形术;移植肾中重度积水、输尿管梗阻者15例,术前经影像学检查确定移植肾盂类型、形态、与周围组织位置关系,应用同侧原输尿管与移植肾盂/输尿管行边侧吻合,其中10例于开放手术前经微创内镜处理失败,4例先期施行经皮穿刺移植肾盂造瘘引流,待血肌酐下降至基线水平,二期再用自体输尿管重建尿路.所有病例均留置双J型输尿管内支架管,一端经自身原输尿管置入受者膀胱,一端置入移植肾盂,术后4～6周经膀胱镜拔除支架管.结果随访6个月至6年,除1例术后5年因慢性排斥反应导致移植肾功能丧失外,其余25例受者肾功能维持基线水平,尿瘘、梗阻肾积水等并发症未复发.结论采用自体输尿管重建尿路能够有效治疗肾盂输尿管高位损伤、尿瘘和输尿管梗阻肾积水等肾移植输尿管并发症,具有手术操作相对简单,尿路并发症复发率低等特点,是非手术方法治疗无效时的优先选择.
목적 회고성분석채용자체수뇨관중건뇨로기술용우치료신이식수뇨관병발증적효과화경험.방법 장채용자체수뇨관중건뇨로적26례신이식수자납입연구,기중남성18례,녀성8례,수자년령위13～55세.26례이식후수뇨관병발증,기중공신신우수뇨관고위손상자3례,우이식술중행공신신우혹수뇨관여자체원수뇨관문합;복잡형뇨루자8례,행자체원수뇨관여이식신우성형술;이식신중중도적수、수뇨관경조자15례,술전경영상학검사학정이식신우류형、형태、여주위조직위치관계,응용동측원수뇨관여이식신우/수뇨관행변측문합,기중10례우개방수술전경미창내경처리실패,4례선기시행경피천자이식신우조루인류,대혈기항하강지기선수평,이기재용자체수뇨관중건뇨로.소유병례균류치쌍J형수뇨관내지가관,일단경자신원수뇨관치입수자방광,일단치입이식신우,술후4～6주경방광경발제지가관.결과 수방6개월지6년,제1례술후5년인만성배척반응도치이식신공능상실외,기여25례수자신공능유지기선수평,뇨루、경조신적수등병발증미복발.결론 채용자체수뇨관중건뇨로능구유효치료신우수뇨관고위손상、뇨루화수뇨관경조신적수등신이식수뇨관병발증,구유수술조작상대간단,뇨로병발증복발솔저등특점,시비수술방법치료무효시적우선선택.
Objective To evaluate the role of native ureter for the management of renal transplantation urological complications retrospectively.Method Twenty-six renal transplant recipients (18 males and 8 females) experienced the following urological complications:upper ureter injury,urinary leaks and moderate or severe ureteric obstructions secondary to ureterovesical anastomotic stricture.These complications have been managed with minimally invasive endourologic techniques or percutaneous nephrostomy as the first-line intervention.While endourologic treatment did not succeed,and the recipients have been treated with intraperitoneal open surgical correction.Urinary continuity was established by pyeloureterostomy or ureteroureterostomy using recipient native ureter.A pigtail ureteral stent was placed with the tip positioned in the pelvis of the graft and native bladder and removed after 4 to 6 weeks.Result The recipients were managed successfully during a follow-up period of 6 months to 6 years without occurrence of urological complications.One case underwent graft loss due to chronic rejection 5 years later postoperation,and the rest developed stable renal function with baseline serum creatinine.Conclusion Excellent outcomes have been achieved by the use of recipient native ureter for the management of urological transplant complications.This simple and efficient procedure should be considered as the superior choice for the recipients who experienced urological complications while less invasive endourologic techniques failed.