肾移植中供肾输尿管异常的处理

目的：探讨肾移植术中供肾输尿管异常的手术处理方法。方法：回顾性分析18例供。肾输尿管异常的肾移植术中处理，包括损伤致输尿管过短8例，完全型双输尿管4例，不完全型双输尿管2例，输尿管结石2例，巨输尿管2例。根据具体情况采用输尿管膀胱吻合术、供受者输尿管端端吻合术和膀胱腰大肌悬吊术等方法再植输尿管。结果：术后恢复顺利，未发生移植肾功能延迟恢复和尿漏。随访3～8年，发生输尿管梗阻1例，行经皮。肾造口输尿管镜切开后治愈。发生尿路感染5例（其中2例为反复感染）。未见膀胱输尿管返流。结扎输尿管的原肾未出现胀痛和不适，B超检查未见肾积水。带输尿管结石移植肾未见结石复发。巨输尿管供肾移植后输尿管管径稳定，无明显增大。结论：供肾输尿管损伤和异常时采用不同的技术修复和再植输尿管，可减少并发症的发生。

Management of Abnormal Ureters of Donor Kidney in Deceased Renal Transplantation

Objective:To explore the operative techniques of transplantation of kidneys having injured or abnormal ureters.Methods:Eighteen cases of transplantation of donor kidney with injured or abnormal ureter were retrospectively analyzed.There were 8 cases of short ureter,4 cases of complete double ureters,2 cases of incomplete double ureters,2 cases of ureteral lithiasis and 2 cases of megaureter.Various methods including ureteroneocystotomy, ureteroureterostomy,and psoas hitch were adopted to repair and implant the ureters.Results:All recipients recovered uneventfully without delayed graft and urine leakage.After a follow-up of 3-8 years,one case of ureteral obstruction of vesicoureteric anastomosis occurred and treated by percutaneous nephrostomy and endoscopic incision. Urinary tract infection occurred in 5 cases including 2 cases of recurrent infection.None of vesicoureteric reflux occurred.None of the recipients with native ureter ligated had infection or post-ligation flank pain,no hydronephrosis was found by ultrasonography in native kidney.No recurrence of urinary lithiasis occurred in recipients received a donor kidney with ureteral stone.The diameter of megaureters remained stable after transplantation.Conclusions: Urinary complications can be avoided while injured and abnormal ureters were repaired and implanted by appropriate methods.