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肾移植术后经手术纠正的早期和晚期泌尿系统并发症。

Early and late urological complications corrected surgically following renal transplantation.

作者信息

Dinckan Ayhan, Tekin Ahmet, Turkyilmaz Serdar, Kocak Huseyin, Gurkan Alihan, Erdogan Okan, Tuncer Murat, Demirbas Alper

机构信息

Akdeniz University Transplantation Center, Antalya, Turkey.

出版信息

Transpl Int. 2007 Aug;20(8):702-7. doi: 10.1111/j.1432-2277.2007.00500.x. Epub 2007 May 19.

Abstract

The purpose of this study was to assess outcomes of urological complications after kidney transplantation operation. Nine-hundred and sixty-five patients received a kidney transplant between 2000 and 2006. In total, 58 (6.01%) developed urological complications, including urinary leakage (n = 15, 1.55%), stenosis (n = 29, 3%), vesicoureteral reflux (VUR) (n = 12, 1.2%), calculi (n = 1, 0.1%) and parenchymal fistulae (n = 1, 0.1%). Urinary leakage cases were treated by ureteroneocystostomy (UNS) via a double-J stent and stenosis cases by UNS. Fenestration was performed in patients developing lymphoceles and unresponsive to percutaneous drainage. VUR treatment was performed by ureteroneocystostomy revision or UNS. Stent usage during ureteric reimplantation was observed to reduce urinary leakage. Surgical complication rates in renal transplantation recipients according to donor type (living versus cadaveric) and the status of stent use (with stent versus without stent) were 5.53% vs. 7.27% (P = 0.064) and 5.24% vs. 20% (P < 0.01) respectively. No recurrence, graft loss or death was seen after these interventions. Comparison of recipients with and without urological complication showed that there was no difference between groups (P > 0.05) with respect to last creatinine level. No graft or patient loss was associated with urological complications. Urological complications that can be surgically corrected should be aggressively treated by experienced surgeons and graft loss avoided.

摘要

本研究的目的是评估肾移植手术后泌尿系统并发症的结果。2000年至2006年间,965例患者接受了肾移植。总共有58例(6.01%)出现泌尿系统并发症,包括尿漏(n = 15,1.55%)、狭窄(n = 29,3%)、膀胱输尿管反流(VUR)(n = 12,1.2%)、结石(n = 1,0.1%)和实质瘘(n = 1,0.1%)。尿漏病例通过双J支架行输尿管膀胱再植术(UNS)治疗,狭窄病例通过UNS治疗。对发生淋巴囊肿且经皮引流无效的患者进行开窗术。VUR治疗通过输尿管膀胱再植术修复或UNS进行。观察到输尿管再植术中使用支架可减少尿漏。根据供体类型(活体与尸体)和支架使用情况(有支架与无支架),肾移植受者的手术并发症发生率分别为5.53%和7.27%(P = 0.064),以及5.24%和20%(P < 0.01)。这些干预后未见复发、移植肾丢失或死亡。有和没有泌尿系统并发症的受者比较显示,两组间末次肌酐水平无差异(P > 0.05)。泌尿系统并发症与移植肾或患者丢失无关。对于可通过手术纠正的泌尿系统并发症,经验丰富的外科医生应积极治疗,避免移植肾丢失。

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