Tyagi Vipin, Jain Saurabh, Singh Mahendra, Pahwa Mrinal, Chadha Sudhir, Rasool Shahnawaz
Department of Urology, Sir Ganga Ram Hospital, New Delhi, India.
Department of Urology, AIIMS, Jodhpur, Rajasthan, India.
Indian J Urol. 2019 Jul-Sep;35(3):218-221. doi: 10.4103/iju.IJU_20_18.
In renal transplant, surgeons use a myriad of ureteral anastomotic techniques. Although ureteroneocystostomy (UNC) using Lich-Gregoir extravesical anastomosis is used most commonly, ureteroureterostomy with native ureter has its own importance in certain situations.
We retrospectively reviewed records of patients who underwent renal transplantation at our center from March 2011 to February 2016. Records of patients who underwent ureteroureterostomy with the native ureter were reviewed for the indications and complications of the procedure.
Of 1050 renal transplants during the study period, 32 patients underwent native ureteroureterostomy. Among these 32 patients, 20 patients were planned preoperatively for native ureteroureterostomy (elective), and intraoperative decision was made in 12 patients (emergency). On follow-up, only one patient had ureteral obstruction due to kink just distal to ureteroureterostomy and was managed by double-J stenting. Other patients had an expected postoperative course.
In our experience, ureteroureterostomy with native ureter is technically and functionally good option for ureteric reimplantation in kidney transplant patients. It can be used selectively for elective and emergency situations where UNC is not possible. Hence, the kidney transplant surgeon should be well versed with both techniques.
在肾移植手术中，外科医生会采用多种输尿管吻合技术。尽管最常使用的是采用利奇 - 格雷戈尔膀胱外吻合术的输尿管膀胱再植术（UNC），但在某些情况下，自体输尿管输尿管吻合术也有其自身的重要性。
我们回顾性分析了2011年3月至2016年2月在本中心接受肾移植患者的记录。对接受自体输尿管输尿管吻合术患者的记录进行了该手术适应证及并发症的评估。
在研究期间的1050例肾移植患者中，有32例接受了自体输尿管输尿管吻合术。在这32例患者中，20例术前计划行自体输尿管输尿管吻合术（择期），12例在术中做出决定（急诊）。随访时，只有1例患者在输尿管输尿管吻合口远端因扭结导致输尿管梗阻，通过置入双J管进行处理。其他患者术后恢复过程正常。
根据我们的经验，对于肾移植患者的输尿管再植，自体输尿管输尿管吻合术在技术和功能上都是一个不错的选择。在无法进行UNC的择期和急诊情况下，它可以被选择性地使用。因此，肾移植外科医生应熟练掌握这两种技术。
