Lasaponara F, Catti M, Morabito F, Volpe A, Manassero F, Ferrando U
Dipartimento di Nefro-Urologia, UOA Urologia, Ospedale San Giovanni Battista, Torino.
Minerva Urol Nefrol. 2000 Dec;52(4):195-9.
We report our experience in transplantation proceedings with the use of small caliber JJ ureteral stent with antireflux valve during uretero-vesical anastomosis.
During renal transplantations we usually perform an uretero-cystoneostomy with antireflux technique according to Lich Gregoir. In the past we used to intubate the uretero-vesical anastomosis only in particular cases; since April 1998 we performed 112 single and 8 double transplants and in all cases we positioned a 12 cm long paediatric 4.8 Ch JJ ureteral stent with antireflux valve, in order to reduce urologic complications. The vesical catheter was usually removed in 6o-7o day and the ureteral stent 40-60 days after transplantation.
We have performed 129 uretero-vesical anastomoses and we complained only one case of early dehiscence of the anastomosis (unilateral in a double transplant) and two cases of late stents' displacement. We noticed no stenosis of the anastomosis and no dysfunction in urine outflow from the upper urinary ways.
The routinary use of paediatric JJ ureteral stents with antireflux valve was decisive in drastically reducing early urologic complications after renal transplantation. Furthermore, the risk of vesico-ureteral reflux is almost completely reduced, thanks to the technique adopted for the anastomosis which allows a physiologic-like antireflux mechanism, to the presence of the antireflux valve and to the early recovery of the physiologic ureteral peristalsis, which is promoted by the small calibre of the stent. These factors lead to a faster recovery of the renal function, with excellent results from the nephrologic and urologic points of view.
我们报告了在输尿管膀胱吻合术中使用带抗反流瓣膜的小口径 JJ 输尿管支架进行移植手术的经验。
在肾移植过程中，我们通常根据利希·格雷戈尔（Lich Gregoir）的抗反流技术进行输尿管膀胱吻合术。过去，我们仅在特定情况下对输尿管膀胱吻合术进行插管；自1998年4月以来，我们进行了112例单肾移植和8例双肾移植，在所有病例中均放置了一根12厘米长的小儿4.8 Ch带抗反流瓣膜的 JJ 输尿管支架，以减少泌尿系统并发症。膀胱导管通常在术后6-7天拔除，输尿管支架在移植后40-60天拔除。
我们进行了129例输尿管膀胱吻合术，仅出现1例吻合口早期裂开（双肾移植中的单侧）和2例晚期支架移位。我们未发现吻合口狭窄，上尿路尿液流出也无功能障碍。
常规使用带抗反流瓣膜的小儿 JJ 输尿管支架对于大幅减少肾移植术后早期泌尿系统并发症起了决定性作用。此外，由于采用了允许类似生理性抗反流机制的吻合技术、抗反流瓣膜的存在以及由支架小口径促进的生理性输尿管蠕动的早期恢复，膀胱输尿管反流的风险几乎完全降低。这些因素导致肾功能更快恢复，从肾病学和泌尿学角度来看效果极佳。
