Universite Paris Descartes, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
J Urol. 2010 Nov;184(5):2043-8. doi: 10.1016/j.juro.2010.06.144. Epub 2010 Sep 18.
Ureteroneocystostomy surgical techniques have been repeatedly debated in the medical literature, in contrast to pyeloureterostomy, which is merely considered a salvage procedure. We assessed urological complications and their management after routine pyeloureterostomy in adult kidney transplantation cases.
We performed a 2-center, uncontrolled, prospective study from January to December 2007. We compared results in 151 consecutive kidney transplantations with routine pyeloureterostomy (group 1) and in 129 procedures with extravesical anti-reflux ureteroneocystostomy (group 2). Perioperative ureteral stenting was done on demand in each group. Major complications included complex leakage, stenosis and surgical revision. Transient leakage or obstruction less than 15 days in duration were considered minor complications.
Recipients in group 1 were more likely to undergo ureteral stenting on demand than those in group 2 (68.9% vs 21.7%). The incidence of overall complications was similar in groups 1 and 2 (9.3% and 13.2%, respectively, p = 0.15), although the major complication rate was higher in group 2. Group 1 recipients had a tendency to require long-term ureteral stenting more often. The only recipient with ureteral necrosis in group 1 was treated with surgical resection and repeat end-to-end ureteroureterostomy. In each group no graft was lost due to urological complications or their management.
Routine pyeloureterostomy is a safe technique that may be a valuable alternative to ureteroneocystostomy for adult renal transplantation. It does not preclude further open re-intervention. Its main advantages include a significant decrease in the risk of surgical re-intervention, the opportunity to perform further endourological procedures on the allograft urinary system and the avoidance of vesicoureteral reflux.
与肾盂输尿管吻合术（被认为仅仅是一种挽救性手术）不同，输尿管-肾盂吻合术的外科技术在医学文献中一直存在争议。我们评估了成人肾移植中常规施行肾盂输尿管吻合术的患者的泌尿系统并发症及其处理方法。
我们进行了一项 2 中心、非对照、前瞻性研究，时间为 2007 年 1 月至 12 月。我们比较了 151 例连续施行常规肾盂输尿管吻合术（第 1 组）和 129 例施行经膀胱外抗反流输尿管-肾盂吻合术（第 2 组）的结果。每组均按需行围手术期输尿管支架置入。主要并发症包括复杂漏尿、狭窄和手术修正。持续时间小于 15 天的暂时漏尿或梗阻被认为是轻微并发症。
第 1 组患者比第 2 组更有可能按需行输尿管支架置入（68.9%比 21.7%）。第 1 组和第 2 组的总体并发症发生率相似（9.3%和 13.2%，p = 0.15），尽管第 2 组的主要并发症发生率更高。第 1 组患者更倾向于需要长期输尿管支架置入。第 1 组中唯一 1 例出现输尿管坏死的患者接受了手术切除和重复端端输尿管-输尿管吻合术。在每组中，没有因泌尿系统并发症或其处理而导致移植物丢失。
常规施行肾盂输尿管吻合术是一种安全的技术，对于成人肾移植来说，可能是输尿管-肾盂吻合术的一种有价值的替代方法。它并不排除进一步的开放性再干预。其主要优点包括显著降低手术再干预的风险、有机会对同种异体泌尿系统进一步施行腔内泌尿外科手术以及避免膀胱输尿管反流。
