肾移植手术输尿管吻合新技术随访评估

FOLLOW-UP EVALUATION OF A NEW URETERAL ANASTOMOSIS TECHNIQUE IN RENAL TRANSPLAN-TATION

目的比较改良的"一针法"技术和传统Lich-Gregoir输尿管吻合技术临床效果。方法2002年1月-2004年12月,对445例慢性肾炎尿毒症患者行肾移植术。121例采用改良的"一针法"技术行膀胱输尿管吻合(新一针法组)。其中男79例,女42例;年龄20～62岁,平均35.7岁。病程2～11年,平均2.7年。324例采用Lich-Gregoir技术(Lich-Gregoir组)。其中男211例,女113例;年龄19～65岁,平均33.9岁。病程1～14年,平均2.3年。两组患者的性别、年龄、原发病、病程差异均无统计学意义(P>0.05)。对两组患者的手术时间及移植术后输尿管和非输尿管并发症进行比较。结果新一针法组和Lich-Gregoir组手术时间分别为(8.7±1.1)min和(22.4±5.1)min,差异有统计学意义(P<0.05)。患者获随访3～5年。新一针法组:5例输尿管漏尿、15例肉眼血尿、4例梗阻以及28例泌尿系感染,未见膀胱输尿管系统性返流发生。Lich-Gregoir组:17例输尿管漏尿、12例肉眼血尿、13例梗阻、6例膀胱输尿管系统性返流、86例泌尿系感染和2例泌尿系结石。其中新一针法组术后肉眼血尿并发症的发生率为12.4%,与Lich-Gregoir组3.7%比较,差异有统计学意义(P<0.05);Lich-Gregoir组和新一针法组输尿管并发症发生率分别为19.8%及15.4%,差异无统计学意义(P>0.05);两组泌尿系感染、移植肾功能延迟恢复和排斥反应的发生率比较,差异无统计学意义(P>0.05)。结论改良的"一针法"技术和Lich-Gregoir技术其总体输尿管并发症发生率无明显差异,但改良的"一针法"技术较Lich-Gregoir技术简便。

Objective To compare the therapeutic effect of new ＂One-Stitch＂ ureterovesical anastomosis to that of the classic Lich-Gregoir method. Methods From January 2002 to December 2004, 445 patients suffering from uremia due to chronic nephritis were treated with renal transplantation. Among them, 121 patients were operated with our new modified ureteroneocystostomy technique （the new One-Stitch group）, and 324 patients were operated with Lich-Gregoir technique （the Lich-Gregoir group）. In the new One-Stitch group, there were 79 males and 42 females, aged 20-62 years （35.7 years on average）. The course of the disease was 2-11 years （2.7 years on average）. In the Lich-Gregoir group, there were 211 males and 113 females, aged 19-65 years （33.9 years on average）. The disease course was 1-14 years （2.3 years on average）. There was no significant difference between the two groups in age, proportion of genders, primary diseases and course of the disease （P 〉 0.05）. The operative time, the ureteral complications and non-ureteral complications were compared between the two groups after the renal transplantation. Results The operative time for the new One-Stitch and Lich-Gregoir techniques was （8.7 ±1.1） minutes and （22.4 ± 5.1） minutes, indicating the difference was significant （P 〈 0.05）. All recipients were followed up for 3-5 years. In the new One-Stitch group, there were 5 patients with leakage of urine, 15 with gross hematuria, 4 with ureteral obstruction and 28 with urinary system infection. Symptomatic vesicoureteral reflux and stone formation were not observed in this group. In the Lich-Gregoir group, there were 17 patients with leakage of urine, 12 with gross hematuria, 13 with ureteral obstruction, 86 with urinary system infection, 6 with symptomatic vesicoureteral reflux and 2 with stones. In the new One-Stitch group, the incidence rate of complications of gross hematuria was 12.4%, which was significantly different from 3.7% in the Lich-Gregoir group （P 〈 0.05）. The incidence rates of ureteral complications in the Lich-Gregoir and the new One-Stitch groups were 19.8% and 15.4%, respectively. The difference was not significant （P 〉 0.05）. There was no significant difference between the two groups in incidence rate of urinary system infection, delayed recovery of kidney function after kidney transplantation and rejection reaction （P 〉 0.05）. Conclusion The new One-Stitch group has no significant difference in ureteral complications comparedwith the Lich-Gregoir group, and has become a preferential ureterovesical reimplantation technique because of its simple and has convenient operation.