Schult M, Küster J, Kliem V, Brunkhorst R, Nashan B, Oldhafer K J, Schlitt H J
Klinik für Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Germany.
Transpl Int. 2000;13(5):340-3. doi: 10.1007/s001470050711.
Necrosis and stenosis of the ureter are severe complications after kidney transplantation and occur with mean incidence of 2,9-13,4 %. Several surgical techniques like simple nephrostomy or complex urinary tract reconstruction have been applied for repair. In this study, our experience with native pyeloureterostomy (NPUS) using the native ureter is presented. Between March 1978 and June 1996, 2,592 kidney transplantations were performed in our institution. In 48 patients (1,9%), secondary urinary tract reconstruction by NPUS was necessary. These patients were evaluated retrospectively by review of the case notes. At the time of operation the mean age was 45 +/- 14 years. Indications for NPUS were distal ureteral stenosis (n = 29), necrosis (n = 17), bleeding (n = 1) or iatrogenic lesion of the ureter (n = 1). The mean time period between transplantation and urinary tract reconstruction was 20 +/- 23 days (range: 1-90 days) for necrosis and 404 +/- 637 days (range: 14-2,385 days) for stenosis. A pyeloureterostomy was technically feasible in all patients using the recipient's ipsilateral ureter. In 40 out of 48 patients the graft developed a normal function postoperatively (follow up: 39 +/- 48 months). A graft nephrectomy was necessary only in one patient, because of complete pyelonnecrosis 6 days after NPUS. Two grafts were lost due to acute rejection. Data of five patients were not available > 15 years after successful reconstruction. We can conclude that NPUS is a safe and simple rescue technique for the treatment of distal ureteral complications after kidney transplantation. Therefore, this technique should be the therapy of choice when secondary reconstruction by re-ureteroneocystostomy is not possible.
输尿管坏死和狭窄是肾移植术后的严重并发症，平均发生率为2.9%-13.4%。已应用多种外科技术进行修复，如单纯肾造瘘术或复杂的尿路重建术。在本研究中，我们介绍了使用自体输尿管进行自体肾盂输尿管吻合术（NPUS）的经验。1978年3月至1996年6月，我们机构共进行了2592例肾移植手术。48例患者（1.9%）需要通过NPUS进行二期尿路重建。通过查阅病历对这些患者进行了回顾性评估。手术时平均年龄为45±14岁。NPUS的适应证为输尿管远端狭窄（n=29）、坏死（n=17）、出血（n=1）或输尿管医源性损伤（n=1）。坏死患者移植与尿路重建的平均间隔时间为20±23天（范围：1-90天），狭窄患者为404±637天（范围：14-2385天）。对所有患者使用受者同侧输尿管进行肾盂输尿管吻合术在技术上是可行的。48例患者中有40例术后移植肾功能恢复正常（随访：39±48个月）。仅1例患者因NPUS术后6天出现完全性肾盂坏死而需要进行移植肾切除术。2例移植肾因急性排斥反应而丢失。5例患者在成功重建15年后的数据无法获取。我们可以得出结论，NPUS是治疗肾移植术后输尿管远端并发症的一种安全、简单的挽救技术。因此，当无法通过再次输尿管膀胱吻合术进行二期重建时，该技术应作为首选治疗方法。
