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目的探讨膀胱黏膜下隧道加膀胱黏膜穿通套入式输尿管膀胱吻合法的临床效果。方法42例肾移植采用膀胱黏膜下隧道加膀胱黏膜穿通套入式输尿管膀胱吻合法行移植肾输尿管与受者膀胱的吻合,游离与移植肾同侧的膀胱外侧顶部,用血管钳在膀胱浆肌层与黏膜间钝性分离一长约1cm的隧道,修剪成卵圆形的输尿管残端从隧道穿过,再通过粘膜上钝性穿通的小孔进入膀胱,在输尿管进入隧道处及进入膀胱处,将输尿管非血管系膜侧与膀胱壁各缝合2～3针固定。结果42例的输尿管吻合手术耗时为5～8min。术后随访3个月至5年,除1例因排斥反应出现输尿管坏死,1例术后早期因输尿管残端止血不彻底致血块堵塞导尿管而引发漏尿外,其余患者均未发生手术相关并发症,无尿液返流。结论膀胱黏膜下隧道加膀胱黏膜穿通套入式输尿管膀胱吻合法操作简单,耗时短,并发症少,安全可靠,并能有效防止尿液返流。
Objective To investigate the clinical effect of bladder submucosal tunnel plus bladder mucosa perforation through ureteric anastomosis. Methods Forty-two cases of renal transplantation underwent bladder submucosal tunneling combined with bladder mucosa penetrating ureteric anastomosis. The anastomosis of the ureter of the recipient kidney and the recipient’s bladder was performed. Layer and mucosa blunt dissection of a tunnel about 1cm long, trimmed into an oval ureteral stump through the tunnel, and then pass through the mucosa blunt puncture into the bladder, enter the tunnel in the ureter and into the bladder Department , The ureter non-vascular mesangial side of the bladder wall suture 2 to 3 needle fixation. Results 42 cases of ureteral anastomosis time-consuming 5 ~ 8min. All cases were followed up for 3 months to 5 years. Except 1 case of ureteral necrosis due to rejection, 1 case had urethral catheter leakage due to blockage of ureter due to ureteral stump hemostasis, Related complications, no urine reflux. Conclusions Bladder submucosal tunnel plus urinary bladder mucosa penetrating ureteric anastomosis method is simple, time-consuming, less complications, safe and reliable, and can effectively prevent the urine reflux.