Decurtins M, Vogt N, Largiadèr F
Department of Surgery, University Hospital, Zürich, Switzerland.
Urol Int. 1992;49(2):90-3. doi: 10.1159/000282400.
After kidney transplantation, urological complications account for significant morbidity necessitating reoperation in a substantial number of patients. In cases with urinary tract necrosis after renal transplantation secondary pyeloureterostomy represents an accepted method for urinary tract reconstruction. In our institution 2% of all kidney grafts required secondary pyeloureterostomy. In all cases the recipient's own ureter was investigated before reoperation by retrograde pyeloureterography. Pyeloureterostomy was performed with a standard technic, the recipients own kidney being removed in all but 5 patients. All 25 patients had normal kidney function immediately after secondary pyeloureterostomy. Urological complications occurred in 7 patients (anastomotic leakages in 4, stenosis in 3); 5 out of 7 complications were managed conservatively (nephrostomy, transureteral stenting). Two patients needed reexploration for reanastomosis. Our results confirm the simple and safe technic of pyeloureterostomy for urinary reconstruction in patients with ureter necrosis after renal transplantation.
肾移植后，泌尿外科并发症导致相当一部分患者出现严重发病情况，需要进行再次手术。在肾移植后继发肾盂输尿管造口术治疗尿路坏死的病例中，这是一种公认的尿路重建方法。在我们机构，所有肾移植中有2%需要进行继发肾盂输尿管造口术。在所有病例中，再次手术前通过逆行肾盂输尿管造影对受者自身输尿管进行检查。采用标准技术进行肾盂输尿管造口术，除5例患者外，其余患者均切除了自身的肾脏。所有25例患者在继发肾盂输尿管造口术后肾功能立即恢复正常。7例患者出现泌尿外科并发症（4例吻合口漏，3例狭窄）；7例并发症中有5例采用保守治疗（肾造瘘、经输尿管支架置入）。2例患者需要再次手术进行重新吻合。我们的结果证实了继发肾盂输尿管造口术用于肾移植后输尿管坏死患者尿路重建的技术简单且安全。
