Waters W B, Herbster G, Jablokow V R, Reda D J
Section of Urology, V.A. Hospital, Hines, Illinois.
J Urol. 1989 Feb;141(2):432-6. doi: 10.1016/s0022-5347(17)40788-9.
Ureteral replacement by ileum is an accepted technique in a highly selective patient population. Two major contraindications in using an ileal ureter are compromised renal function (serum creatinine greater than 2) and a functionally abnormal bladder. We used ileum to bridge a ureteral defect in animals with half of a solitary kidney and low grade azotemia to see if the antirefluxing mechanism of the lower ureter prevented further deterioration in renal function. Twelve female mongrel dogs underwent a right nephrectomy, followed by a left partial nephrectomy six weeks later. Group I (six dogs) had a six cm. segment of ileum interposed between the upper and lower ureteral segments (nonrefluxing). Group II (five dogs) had a ten cm. segment of ileum placed from the upper third of the ureter to the bladder (refluxing). Cystograms, intravenous pyelograms, serum electrolytes, BUN and creatinine were obtained preoperatively, six weeks after the right nephrectomy, one month after left partial nephrectomy and six months after ileal replacement prior to sacrifice. The BUN and creatinine deteriorated in Group II compared to Group I, p = .02 and p = 0.4 respectively (Mann-Whitney test). The BUN and creatinine also deteriorated between one month after left partial nephrectomy and six months after ileal replacement within Group II, p = .07 and p = .14, respectively (Wilcoxon matched-pairs test) but not in Group I. These data suggest that the antirefluxing mechanism of the lower ureter might prevent further deterioration in renal function. We feel that ileum can be used with caution, as an interposition in compromised renal function.
在经过严格筛选的患者群体中，回肠代输尿管是一种被认可的技术。使用回肠代输尿管的两个主要禁忌证是肾功能受损（血清肌酐大于2）和膀胱功能异常。我们用回肠来桥接单肾一半且伴有轻度氮质血症的动物的输尿管缺损，以观察下段输尿管的抗反流机制是否能防止肾功能进一步恶化。12只雌性杂种犬先接受右侧肾切除术，六周后再接受左侧部分肾切除术。第一组（6只犬）在输尿管上下段之间置入一段6厘米长的回肠（抗反流）。第二组（5只犬）从输尿管上三分之一处至膀胱置入一段10厘米长的回肠（反流）。在术前、右侧肾切除术后六周、左侧部分肾切除术后一个月以及回肠代输尿管术后六个月处死动物前，分别获取膀胱造影、静脉肾盂造影、血清电解质、血尿素氮和肌酐数据。与第一组相比，第二组的血尿素氮和肌酐有所恶化，p值分别为0.02和0.4（曼-惠特尼检验）。在第二组中，左侧部分肾切除术后一个月至回肠代输尿管术后六个月期间，血尿素氮和肌酐也有所恶化，p值分别为0.07和0.14（威尔科克森配对检验），但第一组未出现这种情况。这些数据表明下段输尿管的抗反流机制可能会防止肾功能进一步恶化。我们认为，在肾功能受损的情况下，可谨慎使用回肠进行替代。
