Independent risk factors for early urologic complications after kidney transplantation

Urologic complications are the most frequent technical adverse events following kidney transplantation (KTX). We evaluated traditional and novel potential risk factors for urologic complications following KTX. Consecutive KTX recipients between December 1, 2006 and December 31, 2010 with at least six‐month follow‐up (n = 635) were evaluated for overall urologic complications accounting for donor, recipient, and transplant characteristics using univariate and multivariate logistic regression. Urologic complications occurred in 29 cases (4.6%) at a median of 40 d (range 1–999) post‐transplantation and included 17 ureteral strictures (2.6%), five (0.8%) ureteral obstructions due to donor‐derived stones or intraluminal thrombus, and seven urine leaks (1.1%). All except two complications occurred within the first year of transplantation. Risk factors for urologic complications on univariate analysis were dual KTX (p = 0.04) and renal artery multiplicity (p = 0.02). On multivariate analysis, only renal artery multiplicity remained significant (aHR 2.4, 95% confidence interval 1.1, 5.1, p = 0.02). Donation after cardiac death, non‐mandatory national share kidneys, donor peak serum creatinine > 1.5 mg/dL or creatinine phosphokinase > 1000 IU/L, and donor down time were not associated with urologic complications. Our data suggest that donor artery multiplicity is an independent risk factor for urologic complications following KTX.     

腹腔镜技术在泌尿外科中的应用总结(附509例报告)

泌尿外科腹腔镜技术近10余年来取得了飞速发展,但临床上关于手术的许多具体问题仍有分歧,值得探讨.1998年10月至2006年8月,我科采用腹腔镜技术治疗泌尿系疾病共509例,取得较好效果,得到一些经验,供同行参考.(1)手术入路:与腹腔入路相比,后腹腔入路能迅速进入术野,且可更多地借鉴开放手术经验,因此除少数高难度及需要同时处理双侧病变的患者外,建议一般采用后腹腔入路.(2)肾脏切除手术:肾癌手术应于脂肪囊外游离,完整将肾切除,包括肾门周围淋巴组织;＞10 cm的肿瘤或伴有癌栓者考虑开放手术;除上极肿瘤外,不考虑切除肾上腺;行肾盂肿瘤根治术时应防止肿瘤细胞沿输尿管种植.肾切除术中须仔细分离肾脏血管,建议首先以hemo-lock夹闭肾脏动脉.(3)肾上腺手术:腹腔镜肾上腺切除术是肾上腺手术的"金标准",必须根据肾上腺疾病的性质、部位、累及范围和血供特点选择手术方式、手术范围以及相应的术前准备.(4)其他:对前列腺癌根治术等较高难度手术建议根据医生腹腔镜操作的熟练程度和患者身体状况决定是否采用腹腔镜手术;对于精索静脉曲张手术,由于开放手术能较好解决问题,不主张腹腔镜手术.