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背景:下尿路异常能够导致终末期肾病,但是在国内这部分患者没有得到足够的重视,并且因为移植物无功能及脓毒性并发症的高发生率,下尿路异常患者通常被认为不适合进行肾移植。目的:回顾性分析4例下尿路异常患者的肾移植特点及术后随访情况。设计、时间及地点:回顾性病例分析,于2002-07/2006-06在解放军总医院第二附属医院全军器官移植中心完成。对象:接受同种异体肾移植的4例下尿路异常终末期肾病患者。方法:4例患者在肾移植术前接受了详细评估,术中将移植肾输尿管再植入原来膀胱中,尿液引流方式均采取膀胱造瘘方法。主要观察指标:监测肾移植术后患者及移植物存活率、移植肾功能、尿路感染、排斥反应情况,并对患者的生活质量满意度进行评价。结果:①2例患者术后肾功能恢复良好,未发生排斥反应,有轻度但容易控制的尿路感染,患者能够处理尿液引流并对生活质量满意度良好。②1例患者术后17d发生急性排斥反应,治疗后逆转,带有功能移植肾存活至今。③1例患者术后因血管吻合部位反复出血导致移植肾丢失,恢复血液透析治疗。结论:下尿路异常患者可以进行肾移植,但具有特殊性,仔细的术前评估、适当的尿液引流方式以及严密的术后随访是此类患者肾移植成功的关键。
BACKGROUND: Lower urinary tract abnormalities can lead to end-stage renal disease, but not enough attention has been given in this part of the country and patients with lower urinary tract abnormalities are generally considered unsuitable due to the high incidence of graft-less function and septic complications Kidney transplant. Objective: To retrospectively analyze the characteristics of kidney transplantation and the follow-up after operation in 4 cases of lower urinary tract abnormalities. DESIGN, TIME AND SETTING: The retrospective case analysis was performed at the PLA’s Organ Transplant Center, Second Affiliated Hospital of PLA General Hospital from July 2006 to June 2006. PARTICIPANTS: Four patients with lower urinary tract abnormal end-stage renal disease undergoing allograft kidney transplantation. Methods: Four patients underwent a detailed evaluation prior to renal transplantation. Transplanted renal ureters were reimplanted into the original bladder during operation. The urinary drainage methods were all performed by the method of cystostomy. MAIN OUTCOME MEASURES: Survival rates of patients and grafts after renal transplantation, renal graft function, urinary tract infection and rejection were monitored, and the patients’ satisfaction with their quality of life was evaluated. RESULTS: Two patients had good postoperative renal function, no rejection, mild but easily controlled urinary tract infection, and the patients were able to handle urinary drainage and were satisfied with the quality of life. ② One patient developed acute rejection 17 days after operation, reversed after treatment, and survived with functional graft to this day. ③ 1 case of patients with vascular anastomotic sites after repeated bleeding lead to renal allograft loss, recovery hemodialysis treatment. Conclusions: Kidney transplantation is feasible in patients with lower urinary tract abnormalities. However, special renal transplantation is the key to successful renal transplantation in patients with renal transplantation. Careful preoperative evaluation, proper drainage of urine, and close postoperative follow-up are the most important.