Faenza A, Nardo B, Fuga G, Liviano-D'Arcangelo G, Grammatico F, Montalti R, Bertelli R, Beltempo P, Puviani L
Department of Surgery, Intensive Care Unit and Transplantation, University of Bologna, Bologna, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2518-20. doi: 10.1016/j.transproceed.2005.06.079.
In our initial experience of kidney transplantation, we performed an extravesical uretero-cystostomy (U-C), but in 1997 we shifted to a uretero-ureterostomy (U-U) with the aim of reducing early and late urological complications. A data base was constructed to compare the incidence, donor and recipient risk factors, treatments, and outcomes of urological complications with the two techniques. From 1990 to the end of July 2004, 894 kidney transplants included 43 from living donors and 851 from cadaveric donors with 804 first and 47 second transplants. We observed 48 urinary fistulas (5.4%): 45 were successfully repaired and three were treated with a ureteral stent with two good results; and one failed at a late operation. We had 26 early stenoses (2.9%), all of which were successfully treated: 16 with surgery and 10 with a stent. Donor and recipient risk factors for fistula and early stenosis did not reach statistical significance, confirming the technical etiology of these complications. There were only six cases of late ureteral stenosis in patients operated after 1990, and in eight cases of U-C we observed vesico ureteral reflux. There were 88 urological complications, with only one kidney lost. The shift from U-C to U-U did not change the incidence of urological complications, but with U-U we observed a significant decrease in the number of postoperative urinary infections, an easier possibility to resolve ureteral stenosis with endourology and no reflux. It is now our first choice with a normal ureter.
在我们最初的肾移植经验中，我们采用了膀胱外输尿管膀胱吻合术（U-C），但在1997年，我们转而采用输尿管输尿管吻合术（U-U），目的是减少早期和晚期泌尿系统并发症。构建了一个数据库，以比较这两种技术在泌尿系统并发症的发生率、供体和受体风险因素、治疗方法及结果。从1990年到2004年7月底，894例肾移植中包括43例活体供肾和851例尸体供肾，其中804例为首次移植，47例为二次移植。我们观察到48例尿瘘（5.4%）：45例成功修复，3例采用输尿管支架治疗，2例效果良好；1例在后期手术中失败。我们有26例早期狭窄（2.9%），均成功治疗：16例手术治疗，10例采用支架治疗。尿瘘和早期狭窄的供体及受体风险因素未达到统计学意义，证实了这些并发症的技术病因。1990年后手术的患者中仅有6例晚期输尿管狭窄，在8例U-C手术患者中我们观察到膀胱输尿管反流。共有88例泌尿系统并发症，仅1例肾丢失。从U-C转为U-U并未改变泌尿系统并发症的发生率，但采用U-U时我们观察到术后泌尿系统感染的数量显著减少，通过腔内泌尿外科技术更容易解决输尿管狭窄问题且无反流。目前，对于输尿管正常的情况，它是我们的首选方法。
