Pan Xiaoming, Xue Wujun, Tian Puxun, Ding Xiaoming, Yan Hang, Feng Xinshun, Hou Jun, Xiang Heli
Department of Kidney Transplantation, Nephrology Center, the First Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008 Aug;22(8):998-1002.
To compare the therapeutic effect of new "One-Stitch" ureterovesical anastomosis to that of the classic Lich-Gregoir method.
From January 2002 to December 2004, 445 patients suffering from uremia due to chronic nephritis were treated with renal transplantation. Among them, 121 patients were operated with our new modified ureteroneocystostomy technique (the new One-Stitch group), and 324 patients were operated with Lich-Gregoir technique (the Lich-Gregoir group). In the new One-Stitch group, there were 79 males and 42 females, aged 20-62 years (35.7 years on average). The course of the disease was 2-11 years (2.7 years on average). In the Lich-Gregoir group, there were 211 males and 113 females, aged 19-65 years (33.9 years on average). The disease course was 1-14 years (2.3 years on average). There was no significant difference between the two groups in age, proportion of genders, primary diseases and course of the disease (P > 0.05). The operative time, the ureteral complications and non-ureteral complications were compared between the two groups after the renal transplantation.
The operative time for the new One-Stitch and Lich-Gregoir techniques was (8.7 +/- 1.1) minutes and (22.4 +/- 5.1) minutes, indicating the difference was significant (P < 0.05). All recipients were followed up for 3-5 years. In the new One-Stitch group, there were 5 patients with leakage of urine, 15 with gross hematuria, 4 with ureteral obstruction and 28 with urinary system infection. Symptomatic vesicoureteral reflux and stone formation were not observed in this group. In the Lich-Gregoir group, there were 17 patients with leakage of urine, 12 with gross hematuria, 13 with ureteral obstruction, 86 with urinary system infection, 6 with symptomatic vesicoureteral reflux and 2 with stones. In the new One-Stitch group, the incidence rate of complications of gross hematuria was 12.4%, which was significantly different from 3.7% in the Lich-Gregoir group (P < 0.05). The incidence rates of ureteral complications in the Lich-Gregoir and the new One-Stitch groups were 19.8% and 15.4%, respectively. The difference was not significant (P > 0.05). There was no significant difference between the two groups in incidence rate of urinary system infection, delayed recovery of kidney function after kidney transplantation and rejection reaction (P > 0.05).
The new One-Stitch group has no significant difference in ureteral complications compared with the Lich-Gregoir group, and has become a preferential ureterovesical reimplantation technique because of its simple and has convenient operation.
比较新型“一针法”输尿管膀胱吻合术与经典的利奇 - 格雷戈尔（Lich - Gregoir）法的治疗效果。
2002年1月至2004年12月，445例因慢性肾炎导致尿毒症的患者接受了肾移植治疗。其中，121例患者采用我们新改良的输尿管膀胱吻合术技术进行手术（新型一针法组）；324例患者采用利奇 - 格雷戈尔技术进行手术（利奇 - 格雷戈尔组）。新型一针法组中，男性79例，女性42例，年龄20 - 62岁（平均35.7岁）。病程为2 - 11年（平均2.7年）。利奇 - 格雷戈尔组中，男性211例，女性113例，年龄19 - 65岁（平均33.9岁）。病程为1 - 14年（平均2.3年）。两组在年龄、性别比例、原发疾病及病程方面差异无统计学意义（P > 0.05）。肾移植术后比较两组的手术时间、输尿管并发症及非输尿管并发症。
新型一针法和利奇 - 格雷戈尔技术的手术时间分别为（8.7 ± 1.1）分钟和（22.4 ± 5.1）分钟，差异有统计学意义（P < 0.05）。所有受者均随访3 - 5年。新型一针法组中，5例出现尿漏，15例出现肉眼血尿，4例出现输尿管梗阻，28例出现泌尿系统感染。该组未观察到有症状的膀胱输尿管反流和结石形成。利奇 - 格雷戈尔组中，17例出现尿漏，12例出现肉眼血尿，13例出现输尿管梗阻，86例出现泌尿系统感染，6例出现有症状的膀胱输尿管反流，2例出现结石。新型一针法组中，肉眼血尿并发症发生率为12.4%，与利奇 - 格雷戈尔组的3.7%有显著差异（P < 0.05）。利奇 - 格雷戈尔组和新型一针法组输尿管并发症发生率分别为19.8%和15.4%。差异无统计学意义（P > 0.05）。两组在泌尿系统感染发生率、肾移植术后肾功能延迟恢复及排斥反应方面差异无统计学意义（P > 0.05）。
新型一针法组与利奇 - 格雷戈尔组相比，输尿管并发症无显著差异，且因其操作简单方便，已成为一种优先选择的输尿管膀胱再植技术。
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