Singh Shashank, Wani Mohammad S, Bhat Arif H, Khawaja Abdul R, Malik Sajad A, Para Sajjad A, Mehdi Saqib
Urology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, IND.
Cureus. 2023 Jul 10;15(7):e41635. doi: 10.7759/cureus.41635. eCollection 2023 Jul.
Introduction The antiseptic skin preparation, bladder irrigation, corner-saving vascular anastomosis, DJ stenting, and extravesical ureteroneocystostomy (ABCDE) approach encompasses a range of modifications applied during different stages of the surgical procedure in renal transplantation. These modifications include the following: A, antiseptic skin preparation sequentially with cetrimide 3.35%, chlorhexidine scrub 4%, spirit, and povidone-iodine 10%; B, bladder irrigation with amikacin and betadine solution; C, corner-saving end-to-side vascular anastomosis; D, DJ stenting with early postoperative removal within three weeks; and E, extravesical ureteroneocystostomy using our institute's modified Lich-Gregoir technique. Methods This prospective observational study was conducted at our institution between March 2021 and May 2023. Data were collected from the patients' medical records and analyzed using Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY, USA). Statistical tests, including t-test, Mann-Whitney test, chi-square test, and Fisher's exact test, were used for analysis. The study assessed various recipient, donor, intraoperative, and post-transplant factors, as well as surgical complications and stent-related factors. Results Out of 72 renal transplantations, 12 (16.6%) had the following surgical complications: urinary (n = 4; 5.5%), wound-related (n = 3; 4.1%), and lymphocele (n = 5; 6.9%). The most common complications were lymphocele (n = 5; 6.9%) and urinary leak (n = 4; 5.5%). Surgical complications were more common in male recipients (91.6% versus 8.3%), as well as in recipients with longer dialysis duration (24 ± 17 versus 11.0 ± 7 months) and had extended hospitalization time (16.4 ± 8.6 versus 8.0 ± 2.9 days) (p < 0.05). Wound infection correlated with longer surgeries (>300 minutes) and other complications. Lymphocele patients had higher drain output (>500 mL) on day 1 and longer hospital stays (>15 days). Urinary tract infections (UTIs) were linked to dialysis duration (>24 months), diabetes, and longer indwelling times of DJ stents and urinary catheters. Early DJ stent removal (<3 weeks) reduced UTI incidence and symptoms (p < 0.05). All complications were categorized as minor (3a or less), according to the Clavien-Dindo classification. Conclusion The modified ABCDE surgical approach in renal transplantation decreased the complications, showing favorable outcomes compared to those in the literature.
引言 抗菌皮肤准备、膀胱冲洗、保留角的血管吻合、DJ 支架置入以及膀胱外输尿管膀胱吻合术（ABCDE）方法涵盖了肾移植手术不同阶段所应用的一系列改良措施。这些改良措施包括：A，依次用 3.35%的西曲溴铵、4%的氯己定擦洗剂、酒精和 10%的聚维酮碘进行抗菌皮肤准备；B，用阿米卡星和聚维酮碘溶液进行膀胱冲洗；C，保留角的端侧血管吻合；D，术后三周内尽早取出的 DJ 支架置入；E，采用本研究所改良的 Lich-Gregoir 技术进行膀胱外输尿管膀胱吻合术。方法 这项前瞻性观察性研究于 2021 年 3 月至 2023 年 5 月在本机构进行。从患者病历中收集数据，并使用社会科学统计软件包（SPSS）（IBM SPSS Statistics，美国纽约州阿蒙克）进行分析。使用包括 t 检验、曼-惠特尼检验、卡方检验和费舍尔精确检验在内的统计检验进行分析。该研究评估了各种受者、供者、术中及移植后因素，以及手术并发症和支架相关因素。结果 在 72 例肾移植中，12 例（16.6%）出现了以下手术并发症：泌尿系统（n = 4；5.5%）、伤口相关（n = 3；4.1%）和淋巴囊肿（n = 5；6.9%）。最常见的并发症是淋巴囊肿（n = 5；6.9%）和尿漏（n = 4；5.5%）。手术并发症在男性受者中更常见（91.6%对 8.3%），以及在透析时间较长的受者中（24±17 对 11.0±7 个月），且住院时间延长（16.4±8.6 对 8.0±2.9 天）（p < 0.05）。伤口感染与手术时间较长（>300 分钟）和其他并发症相关。淋巴囊肿患者在第 1 天引流液量较高（>500 mL）且住院时间较长（>15 天）。尿路感染（UTIs）与透析时间（>24 个月）、糖尿病以及 DJ 支架和导尿管留置时间较长有关。早期取出 DJ 支架（<3 周）可降低 UTI 的发生率和症状（p < 0.05）。根据 Clavien-Dindo 分类，所有并发症均被归类为轻度（3a 级或更低）。结论 肾移植中改良的 ABCDE 手术方法减少了并发症，与文献中的结果相比显示出良好的效果。
