Cerilli J, Anderson G W, Evans W E, Smith J P
Surgery. 1976 Mar;79(3):248-52.
Patients with chronic renal failure and total diversion of the lower urinary tract have been considered poor transplant candidates, and post-transplant urinary diversion, i.e., Bricker loop, has been thought to be necessary. Our experience with nine patients clearly indicates that these patients are actually excellent transplant candidates and that post-transplant urinary diversion rarely is necessary. Ureteroneocystostomy of the allografted ureter was performed in seven patients with pretransplant total urinary diversion and all have completely normal bladder and renal function 10 to 66 months after transplantation; the two patients with Bricker loop procedures performed at transplantation died 7 months after transplantation of rejection and pancreatitis. The excellent results achieved with ureteroneocystostomy are attributed to (1) errors in diagnosis resulting in inappropriate bladder or ureteric surgery early in the course of the patient's disease; (2) confusion of immunologic of functional disorders with anatomic problems; (3) growth and development of the bladder, and (4) complete control of chronic bladder infection by pretransplant nephrectomy, ureterectomy, and antibiotics.
慢性肾功能衰竭且下尿路完全改道的患者一直被认为是肾移植的不良候选者，并且认为移植后尿路改道（即Bricker袢）是必要的。我们对9例患者的经验清楚地表明，这些患者实际上是优秀的移植候选者，而且移植后很少需要尿路改道。7例移植前有完全尿路改道的患者接受了同种异体输尿管的输尿管膀胱吻合术，移植后10至66个月，所有患者的膀胱和肾功能均完全正常；另外2例在移植时进行了Bricker袢手术的患者在移植后7个月死于排斥反应和胰腺炎。输尿管膀胱吻合术取得的优异结果归因于：（1）诊断错误导致在患者病程早期进行了不适当的膀胱或输尿管手术；（2）将免疫或功能障碍与解剖问题相混淆；（3）膀胱的生长发育；（4）通过移植前肾切除术、输尿管切除术和抗生素对慢性膀胱感染进行了完全控制。
