Laftavi M R, Chaudhry Q, Kohli R, Feng L, Said M, Paolini K, Dayton M, Pankewycz O
Department of Surgery, Division of Transplantation.
Department of Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY, USA.
Int J Organ Transplant Med. 2011;2(2):66-74.
Despite significant advancements in renal transplantation, certain basic surgical practices such as the routine use of ureteral stents (US) remain controversial. A recent met-analysis of ureteral stenting concluded that the routine use of US resulted in improved outcomes. In contrast, the indiscriminate use of US can lead to adverse complications.
To better define this question, we reviewed our single center experience in which US were placed selectively.
301 patients were eligible to be enrolled. 55 living donor and 246 deceased-donor charts were analyzed for donor and recipient clinical characteristics, immunosuppressive therapy and outcomes.
28 US were placed for either small bladder capacity (n=7), unhealthy appearing bladder tissue (n=8) or for an uncertain vascular supply to the ureter (n=13). Patients with US did not develop urinary leaks, 8 (28%) developed complications including obstruction, encrustation, and urinary tract infections. 12 (4.3%) non-stented patients developed a clinically significant urinary leak. Risk factors for urinary leaks included dual and en-bloc pediatric donor kidney transplants, extended criteria donors and the use of single U stitch technique for ureteral anastomoses.
Our results demonstrate that the majority of patients can be successfully transplanted without the routine use of US. Selective use of US should be reserved for high-risk situations.
尽管肾移植取得了重大进展，但某些基本外科手术操作，如输尿管支架（US）的常规使用仍存在争议。最近一项关于输尿管支架置入的荟萃分析得出结论，常规使用US可改善预后。相比之下，不加区分地使用US可能导致不良并发症。
为了更好地界定这个问题，我们回顾了我们单中心选择性放置US的经验。
301例患者符合入组条件。分析了55例活体供体和246例尸体供体的图表，以了解供体和受体的临床特征、免疫抑制治疗及预后情况。
因膀胱容量小（n = 7）、膀胱组织外观不健康（n = 8）或输尿管血供不确定（n = 13）而放置了28个US。放置US的患者未发生尿漏，8例（28%）出现并发症，包括梗阻、结痂和尿路感染。12例（4.3%）未放置支架的患者发生了具有临床意义的尿漏。尿漏的危险因素包括双肾和整块小儿供肾移植、扩大标准供体以及输尿管吻合采用单U形缝合技术。
我们的结果表明，大多数患者无需常规使用US即可成功进行移植。US的选择性使用应保留用于高危情况。
