[肾移植术后输尿管并发症的外科修复结果]

[Results of surgical revisions for ureteral complications after renal transplantation].

作者信息

Abdo N, Murez T, Cabaniols L, Robert M, Marchal S, Amadane N, Thezenas S, Iborra F, Thuret R

机构信息

Service d'urologie et de transplantation rénale, CHU de Montpellier, 34295 Montpellier cedex 5, France.

出版信息

Prog Urol. 2019 Sep;29(10):474-481. doi: 10.1016/j.purol.2019.05.010. Epub 2019 Aug 7.

DOI:10.1016/j.purol.2019.05.010

PMID:31400962

Abstract

OBJECTIVE

To analyze the results of surgical revision for ureteral complication (ureteric stenosis or urinary leakage) after renal transplantation over a period of 10 years.

MATERIALS AND METHODS

We performed a retrospective study on 1313 consecutive kidney transplantations carried out in a University Hospital Center between 2005 and 2014. The data of the patients who developed a ureteral stenosis or a urinary leakage secondary to a renal transplantation were analyzed. Combined organ transplantations (kidney-liver and kidney-pancreas), as well as pediatric transplantations were excluded.

RESULTS

Seventy-six patients (5.8%) had ureteric stenosis or urinary leakage after renal transplantation. Forty-six patients (3.5%) underwent surgical revision: 27 for ureteral stenosis, 19 for urinary leakage. Early success was achieved in 26 patients (56.5%), including 14 ureteric stenosis (51.9%) and 12 urinary leakage (63.2%) (P=0.45). After a complementary endoscopic or surgical treatment, the final success rate was increased to 73.1% (34 patients): 20 ureteric stenosis (74.1%) and 14 urinary leakage (73.7%) (P=0.98). There were 2 graft losses (4.3%) and one death (2.2%). The mean glomerular filtration rate estimated by the MDRD was 44.58mL/min/1.73m (±14.7) before surgery and 45.37mL/min/1.73m (±16.5) 6 months after surgery (P=0.92).

CONCLUSION

Although frequently challenging, surgical revisions for ureteral complications after renal transplantation give good results, with a low rate of graft loss and mortality.

LEVEL OF EVIDENCE

摘要

目的

分析10年间肾移植术后输尿管并发症（输尿管狭窄或尿漏）的手术翻修结果。

材料与方法

我们对2005年至2014年在一所大学医院中心进行的1313例连续肾移植进行了回顾性研究。分析了发生肾移植继发输尿管狭窄或尿漏的患者数据。排除联合器官移植（肾 - 肝和肾 - 胰）以及儿科移植。

结果

76例患者（5.8%）肾移植后出现输尿管狭窄或尿漏。46例患者（3.5%）接受了手术翻修：27例因输尿管狭窄，19例因尿漏。26例患者（56.5%）早期成功，包括14例输尿管狭窄（51.9%）和12例尿漏（63.2%）（P = 0.45）。经过补充性内镜或手术治疗后，最终成功率提高到73.1%（34例患者）：20例输尿管狭窄（74.1%）和14例尿漏（73.7%）（P = 0.98）。有2例移植肾丢失（4.3%）和1例死亡（2.2%）。术前通过MDRD估算的平均肾小球滤过率为44.58mL/min/1.73m²（±14.7），术后6个月为45.37mL/min/1.73m²（±16.5）（P = 0.92）。