Del Pizzo J J, Jacobs S C, Bartlett S T, Sklar G N
Department of Surgery, University of Maryland School of Medicine, Baltimore, USA.
Br J Urol. 1998 Apr;81(4):543-7. doi: 10.1046/j.1464-410x.1998.00619.x.
To examine the spectrum of urological complications associated with bladder drainage of pancreatic allografts.
Between July 1991 and October 1996, 140 consecutive bladder-drained pancreatic allografts were performed and were reviewed retrospectively to determine the spectrum of post-operative urological complications. Ninety-five patients (68%) underwent simultaneous pancreas-kidney transplantation, 35 (25%) had the pancreas transplanted after the kidney, while 10 (7%) had a pancreas transplant alone. The mean follow-up was 35 months.
Seventy patients (50%) had urological complications necessitating intervention: 17 (12%) had retained foreign bodies, bladder tumours occurred in three, 14 had bladder calculi and 15 (11%) had cystoscopic evidence of duodenitis. One patient developed an arteriovenous fistula and one had a necrotic duodenal allograft. Reflux pancreatitis occurred in six patients. Other complications included urethral stricture (three), urethral erosion (three), epididymitis (three), acute prostatitis (one) and prostatic abscess (one). One patient developed a urethrocutaneous fistula and another developed a vesicocutaneous fistula. In the series, 30 of the 140 patients (21%) required eventual conversion to enteric drainage of their allograft as definitive therapy.
Pancreatic transplantation with bladder drainage is associated with a wide range of significant urological problems. Although appropriate treatment can resolve most of the complications, this often entails additional operative intervention, which may increase the long-term morbidity or jeopardize graft function. As a result of the severity of these urological complications, some centres use primary enteric drainage as the method of choice for pancreatic transplantation.
研究胰腺同种异体移植膀胱引流相关的泌尿系统并发症谱。
1991年7月至1996年10月，连续进行了140例膀胱引流胰腺同种异体移植手术，并进行回顾性分析以确定术后泌尿系统并发症谱。95例患者（68%）同时接受了胰肾联合移植，35例（25%）在肾移植后进行了胰腺移植，10例（7%）仅接受了胰腺移植。平均随访时间为35个月。
70例患者（50%）出现需要干预的泌尿系统并发症：17例（12%）有异物残留，3例发生膀胱肿瘤，14例有膀胱结石，15例（11%）经膀胱镜检查有十二指肠炎症。1例患者发生动静脉瘘，1例有十二指肠移植胰腺坏死。6例患者发生反流性胰腺炎。其他并发症包括尿道狭窄（3例）、尿道糜烂（3例）、附睾炎（3例）、急性前列腺炎（1例）和前列腺脓肿（1例）。1例患者发生尿道皮肤瘘，另1例发生膀胱皮肤瘘。在该系列中,140例患者中有30例（21%）最终需要将移植胰腺改为肠道引流作为确定性治疗。
膀胱引流胰腺移植与一系列严重的泌尿系统问题相关。尽管适当的治疗可以解决大多数并发症，但这通常需要额外的手术干预，这可能会增加长期发病率或危及移植胰腺功能。由于这些泌尿系统并发症的严重性，一些中心将原发性肠道引流作为胰腺移植的首选方法。
