改良拖入式免置DJ管输尿管膀胱吻合术在肾移植中的应用体会

Application experience of implanted ureteroneocystostomy without double J tubes in renal transplantation

目的探讨肾移植术中简易、可靠、快速的输尿管膀胱吻合方式。方法回顾性分析1995年3月至2016年1月潍坊市人民医院泌尿外科320例肾移植受者临床资料。根据受者输尿管膀胱吻合方式不同分为常规组(75例,采用黏膜下隧道式)和改良组(245例,采用改良拖入式免置DJ管输尿管膀胱吻合术)。观察比较两组受者输尿管膀胱吻合时间及术后2年内泌尿系统并发症发生情况。采用成组t检验比较两组吻合方式的手术时间,采用χ2检验比较两组术后2年内泌尿系统并发症发生情况。P<0.05为差异有统计学意义。结果截至2016年1月,所有受者术后平均随访(6.5±0.6)年(0.5~8.0年)。常规组和改良组输尿管膀胱吻合时间分别为(10.0±1.3)、(4.0±1.2)min,差异有统计学意义(t=6.573,P<0.05)。常规组和改良组术后2年内发生输尿管末端乳头狭窄、尿渗或者尿漏、尿路感染、早期肉眼血尿和膀胱输尿管返流百分比分别为6.67%(5/75)和1.22%(3/245)、6.67%(5/75)和0.82%(2/245)、2.67%(2/75)和0.82%(2/245)、2.67%(2/75)和0.82%(2/245)、9.33%(7/75)和0,差异均有统计学意义(χ2=4.955、9.185、1.593、1.593、23.378,P均<0.05)。改良组受者术后6~12个月经膀胱镜检查,均可于膀胱左侧(或右侧)后顶壁(大约10点或2点时钟方向)见约2 cm长管状隆起,与周围膀胱粘膜完全融合,并可见移植肾输尿管末端管口。结论较传统隧道式吻合术,拖入式输尿管膀胱吻合术手术方法简便、吻合时间短、无需留置DJ管、抗返流效果确切且术后泌尿系统并发症少,是一种值得推广的改良术式。

Objective To explore the simple,reliable and rapid ureteroneocystostomy in renal transplantation. Methods The clinical data of 320 cases of recipients who performed renal transplantion in Weifang People＇s Hospital from March 1995 to January 2016 was retrospectively analyzed. All the recipients were divided into two groups according to the ureteroneocystostomy： conventional group（75 cases,submucosal tunnel type） and modified group（245 cases,modified drag-and-drop catheter for ureteroneocystostomy）. The time of ureteroneocystostomy and urinary system complications within2 years after renal transplantion between the two groups were compared by t test and Chi-squared test,respectively. P〈0. 05 was considered statistically significant. Results All patients were followed up for an average of（6. 5 ± 0. 6） years（0. 5 to 8. 0 years） up to January 2016. The time of ureteroneocystostomy of conventional group and modified group were（10. 0 ± 1. 3） min and（4. 0 ±1. 2） min,the difference was statistically significant（t = 6. 573,P〈0. 05）. The incidence of terminal ureteral stricture, urinary extravasation, urine leakage, urinary tract infection and vesicoureteral reflux between the two groups were 6. 67%（5/75） and 1. 22%（3/245）,6. 67%（5/75） and 0. 82%（2/245）,2. 67%（2/75） and 0. 82%（2/245）,2. 67%（2/75） and 0. 82%（2/245）,9. 33%（7/75） and 0,the difference was statistically significant（χ-2= 4. 955,9. 185,1. 593,1. 593 and 23. 378,P all 0. 05）. Ureter papilla（about 2 cm long） could be found in all the recipients in 6 to 12 months after renal transplantion proved by bladder endoscopy,which bonded integratedly with surrounding tissues. Conclusions Compared with submucosal tunnel type, the modified ureteroneocystostomy without double J tubes had simpler surgical method,shorter anastomosis time,more effective anti-reflux mechanism and fewer urinary system complications,which was worth of being generalized.