输尿管内插管技术在小鼠肾脏移植中的应用

Application of intraureteral cannula technique in reconstruction of urinary tract in mice kidney transplantation

目的为了降低小鼠肾移植模型中尿路重建相关并发症的发生率，探讨输尿管内插管技术在肾移植术尿路重建的可行性及优越性。方法运用肾移植模型，对比输尿管内插管术与输尿管膀胱．膀胱吻合术在冷缺血时间、尿路重建时间、输尿管并发症的发生率、肾脏病理改变、小鼠长期存活率是否存在差异。结果输尿管膀胱-膀胱吻合术组冷缺血时间为（22．3±2．9）min，输尿管内插管术组为（18．4±2．7）min（P=0．001）。行输尿管膀胱-膀胱吻合术组耗时为（3．4±0．4）min，而输尿管内插管术组耗时为（1．6±0．4）min（P=0．000）。手术10d后观察，输尿管膀胱-膀胱吻合术组其膀胱坏死、尿漏、肾盂积水和膀胱结石的发生率分别为53．3％、46．6％、53．3％和26．7％。与输尿管膀胱一膀胱吻合术组比较，采用输尿管内插管术组的膀胱坏死率为0％（P=0．002）、尿漏率为6．7％（P=0．035）、肾盂积水率为0％（P=0．042）和膀胱结石率为0％（19=0．050）。手术10周后观察，输尿管膀胱-膀胱吻合术后出现肾实质坏死和炎性细胞浸润，而输尿管内插管术后未发现明显异常。输尿管内插管术组小鼠10周的生存率高于输尿管膀胱-膀胱吻合术（73．3％比53．3％，P=0．336）。结论输尿管内插管术在肾移植尿路重建中具有一定的优越性及可行性，其具有潜在的临床参考价值。

Objective To reduce the complication of urine reconstruction in mice kidney trans- plantation. We explore the feasibility and superiority of intraureteral cannula technique. Methods To compare conventional urinary reconstruction with intraureteral cannula technique in mice kidney transplan- tation, we evaluated the cold isehemia time, the operation time, urinary complication, renal pathology, and long - term survival rates. Results The cold ischemia time of conventional urinary reconstruction was （22. 3±2.9） min, and intraureteral cannula was （ 18. 4±2. 7） min （P =0. 001 ）. The operation time of conventional urinary reconstruction was （ 3.4 ± O. 4） rain, and intraureteral cannula was （ 1.6 ± 0. 4） rain （P = 0. 000）. After 10 days, we found that bladder necrosis, urine leakage, hydronephrosis, and calculi formation were common complications in conventional urinary reconstruction with the incidence of 53.3%, 46. 6% , 33.3% , and 26. 7% , respectively. In intraureteral cannula technique, bladder necrosis was 0% （P =0. 002） , urine leakage was 6. 7% （P =0. 035）, hydronephrosis was 0% （P =0. 042） , calculi for- mation was 0% （P = 0. 050）. Ten weeks after conventional urinary reconstruction, patty necrosis of renal parenchyma together with the infiltration of inflammatory ceils was found, no obvious abnormal pathologic change was found in the renal parenchyma and mesenchyma after transplantation with intraureteral cannula technique. Our data indicated that long -term survival over 10 weeks was much better in the ureteric can-nula group （73.3%）, which was higher than that （53.3%, P=0. 336） in the conventional urinary re- construction. Conclusion The studie indicates that intraureteral cannula technique has the feasibility and superiority of urinary reconstruction in kidney transplantation. Intraureteral cannula technique has a poten- tial therapeutic option for clinic, and provides a new therapeutic stratagem for urinary reconstruction of kid- ney transplantation in the future.