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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。
OBJECTIVE: To compare the three urinary tract reconstruction methods in rat kidney transplantation and screen the surgical plans with good stability and few complications. Methods Three kinds of surgical procedures were used to reconstruct the urinary tract of rats with renal allografts: group A, donor / recipient anastomosis (n = 14), group B, donor bladder flap - recipient anastomosis (n = 15); Group C, donor ureter-recipient bladder myometrial tunneling (n = 17). Urinary tract reconstruction time of each group, urinary tract complications and serum creatinine were compared. Results The operation time in group A, B and C were (6 ± 2.0) min (14 ± 2.5) min and (7 ± 2.0) min, respectively. There was no significant difference between group A and group C, The incidence of ureteral obstruction in group A was the highest (21.4%), and the incidence of urinary leakage was the highest in group B (13.3%). The postoperative urinary tract complications The overall incidence was lowest (11.8%). The total incidence of postoperative urinary complications was 28.5% and 26.1% in group A and B, respectively, with statistical significance (P <0.05) Monitoring showed that the difference between group A and group C 40 d after operation was statistically significant (P <0.05). The difference between group B and C 60 d after operation was statistically significant (P <0.05). Conclusions There is little urinary tract complications after tunnel anastomosis of the donor ureter - receptor bladder myometrium, which has little effect on the recovery of transplanted kidneys. It is an ideal solution for urinary tract reconstruction in rat kidney transplantation.