自体膀胱瓣管移植肾肾盂吻合术处理输尿管坏死

Clinical study of the use of bladder flap for total transplant ureteral reconstruction

目的探讨自体膀胱瓣管移植肾肾盂吻合术处理肾移植术后输尿管长段坏死的效果。方法13例患者肾移植术后发生输尿管长段坏死,将其膀胱皮瓣围绕输尿管内支架管(双J管)缝合成管状,以代替坏死的输尿管,上部修剪成斜形后,与移植肾肾盂吻合。留置双J管做支架管,切口留置胶管引流。结果13例患者均成功进行移植肾肾盂膀胱瓣管吻合术,其中1例术后7d发生严重肾周感染而切除移植肾,其余12例肾功能恢复良好,术后随访1年,2例出现返流,人、肾1年存活率分别为100%(13/13)、92.3%(12/13)。结论自体膀胱瓣管移植肾肾盂吻合术是治疗肾移植术后输尿管长段坏死的有效手段。

Objective To study the effectiveness of the complete ureterel reconstruction using bladder flap after cadaveric renal transplantaion.Methods In 13 recipients with complete necrosis of ureter after renal transplant from July 1995 to October 2003, tubelike bladder flaps were applied to ureteraplasty substitute for the necrosis ureter. Artificial pyeloureterostomy was performed and double T tubes were used as the stents. Routine drainage-tubes were placed in incisions. Results All patients were successful in ureteral reconstruction. The renal function of 10 patients was improved significantly 4 weeks postoperation. Nephrectomy was performed in one patient because of severe circumrenal infection 7 days after operation. One-year survival rate of recipients and allografts was ~100 % (13/13) and ~92.3 % (10/13) respectively. Urine reflow occurred in 2 patients during a follow-up of 12 months. Conclusion The use of bladder flap for ureteral reconstruction is an effective technique for total autograft ureteral necrosis.