下尿路异常患者的肾移植

目的] 探讨下尿路异常病人的肾移植手术方法.方法] 2001年 6月至 2003年 7月对 4例合并下尿路异常患者实施肾移植手术.其中 1例行肾移植 移植肾输尿管皮肤造口, 2例分别行同期及分期肾移植 回肠膀胱术, 1例肾移植术后 2月余行前列腺电切术. 4例患者均加用赛尼哌 (zenapax)作免疫抑制诱导治疗,维持治疗方案为他克莫司 (FK506)或环孢素 (CsA) 霉酚酸酯 (MMF) 激素 (steroid). 结果] 接受输尿管造口及分期回肠膀胱术的患者均未出现术后并发症;接受同期回肠膀胱术患者术后出现便血和尿瘘,治疗后消失;接受前列腺电切术患者术后尿流通畅,无尿路并发症,后因严重肺炎放弃治疗.结论] 下尿路异常患者的肾移植手术,可根据患者情况同期或分期完成肾移植和改善下尿路手术,应最大限度保障移植肾功能与输尿管引流通畅.

Kidney Transplantation in Patients with Abnormal Lower Urinary Tract

ObjectiveTo explore the method of kidney transplantation in the patients with abnormal lower urinary tract. MethodsKidney transplantation were performed for 4 cases with abnormal lower urinary tract from June 2001 to July 2003. One of them was performed kidney transplantation and cutaneous ureterostomy simultaneously. Two of them experienced kidney transplantation and ileal conduit respectively by one stage and by two steps. Another recipient was performed transurethral resection of the prostate (TURP) two months after kidney transplantation. All of the 4 cases received zenapax as the induced-immunosuppressive therapy and tacrolimus (FK506) or cyclosporine A (CsA) mycophenolate mofetil (MMF) steroid (prednisone) as the maintenance therapy. ResultsThe patient who received ileal conduit by one stage experienced hematochezia and urinary fistula which vanished after effective treatment. The patient who received TURP experienced pneumonia which was not related to TURP. Another two patients recovered smoothly. ConclusionAccording to the condition of the recipient with abnormal lower urinary tract, the operation of kidney transplantation and urinary diversion should be completed by one stage or by two steps. The function of the kidney and the drainage of the ureter should be protected.