大鼠肾移植三种尿路重建术式的比较

目的 对大鼠肾移植3种尿路重建术式进行比较,筛选出稳定性好、并发症少的手术方案.方法 以3种术式进行大鼠同系肾移植尿路重建:A组,供/受体输尿管端端吻合术(n=14);B组,供体膀胱瓣-受体膀胱吻合术(n=15);C组,供体输尿管-受体膀胱浆肌层隧道术(n=17).对各组尿路重建时间、尿路并发症以及血肌酐动态指标进行比较.结果 A、B、C 3组手术时间分别为(6±2.0)min、(14±2.5)min、(7±2.0)min, A组与C组差异无统计学意义, B组用时分别与A组、C组差异有统计学意义(P＜0.05);术后,A组输尿管梗阻发生率最高(21.4%),B组尿漏发生率最高(13.3%);C组术后尿路并发症总发生率最低,为11.8%,A、B两组术后尿路并发症总发生率分别为28.5%和26.1%,与C组之间差异均有统计学意义(P＜0.05);血肌酐监测显示A组术后40d与C组差异有统计学意义(P＜0.05),术后60d与B、C两组间差异有统计学意义(P＜0.05).结论 供体输尿管-受体膀胱浆肌层隧道吻合术后尿路并发症少,对移植肾恢复影响小,是大鼠肾移植尿路重建的较理想方案.

Comparision among three ways of urinary tract reconstruction of kidney transplantation in rats

Objective To compare three ways of uninary tract reconstruction in rats kidney transplantation and to filt the best one with most stabilities and lees complications.Metholds To utilize three ways following to reconstruct uninary tract in rats isograft kidney transplantation.In group A,fourteen models were performed end-to-end anastomosis procedure to reconstruct ureter at inferior pole of kidney.In group B,fifteen models were connected ureter attaching part of bladder with the bladder were conducte.In group C,seventeen models were performed ureter reconstruction by way of embeding the donors' ureter into the recepters' plasma-muscular layer of bladder.To compare the average operation time of urinary tract reconstruction and incidence of complications after operation,the level of serum creatinine were deteced on postoperative 10d,20d,30d,40d and 60d.Results The average time of uninary tract reconstruction had significant diviation between group B with group A(P<0.05)and group C(P<0.05).The rate of obstruction of ureter was highest in group A(21.4%)and the rate of leakage of urine was highest in group B(13.3%).The total rate of complication postoperative had significant diviation between group C(11.8%) with group A(28.5%)and group B(26.1%).There were significant diviation betwween group A with group C on day 40(P<0.05)and group B on day 60(P<0.05)postoperative at level of serum creatinine.Conclusion By way of embed the donors' ureter into the recepters' plasma-muscular layer of bladder to reconstruct uninary tract will meet lower complication rate and higher stability.