Urinary Tract Complications in Elderly Kidney Transplant Recipients
Oct 20, 2022
Cov teeb meem urinary nyuaj thiab mob hnyav yog qhov tseem ceeb rau kev tsis ua haujlwm ntawm lub raum hloov pauv thiab tuag ntawm lub raum hloov pauv. Vim lub zais zis cov leeg atrophy, pom tseeb cov ntaub so ntswg fibrosis, thiab txo cov ntaub so ntswg muaj peev xwm kho, thiab cov neeg laus cov txiv neej feem ntau muaj teeb meem nrog cov kab mob urinary qis xws li prostatic hyperplasia, postoperative urinary to, vesicoureteral reflux, thiab urinary tract infections yuav tshwm sim nyob rau hauv kev hloov. cov neeg txais. thiab txo qis cov kab mob urinary ob leeg thiab lwm yam teeb meem, nws yog ib qho tsim nyog yuav tsum tau muab qhov tseem ceeb rau kev siv cov kev tiv thaiv zoo.
Nyem rau Rong rong cistanche rau mob raum
Kev Xaiv Txoj Kev Siv Cov Kab Mob Urinary Reconstruction Methods for Elderly Kidney Transplantation
Cov neeg laus lub raum hloov pauv feem ntau yog qhov muaj feem pheej hmoo ntawm postoperative urinary fistula thiab vesicoureteral reflux vim kev noj zaub mov tsis zoo, ntshav qab zib, thiab cov tsos mob ntawm cov zis qis. Yog li ntawd, xaiv txoj kev tsim cov urinary zoo dua thaum lub sij hawm hloov pauv tuaj yeem tiv thaiv kev mob urinary tom qab. Muaj ob yam tseem ceeb ntawm cov zis rov tsim kho hauv lub raum hloov pauv: ureterovesical anastomosis thiab ureteroureteral anastomosis. Tam sim no, ureterovesical anastomosis yog dav siv nyob rau hauv cov chaw hloov pauv, thiab ureter anastomosis feem ntau yog siv los ntsuas kev khaws cia tom qab qhov tsis ua tiav ntawm kev hloov pauv thawj zaug. Qhov zoo ntawm ureterovesical anastomosis yog qhov kev ua haujlwm yooj yim thiab txuag lub sijhawm, tab sis cov txheej txheem tiv thaiv reflux tsis zoo tag nrho, thiab lub sijhawm ntawm vesicoureteral reflux tom qab hloov pauv yog siab.
Transplanted ureteroautologous ureteral anastomosis is suitable for recipients with lower urinary tract diseases such as short donor ureters and small bladder capacity caused by bladder fibrosis, especially elderly patients. Since the required length of the ureter for the kidney is 4.0-5.0 cm, it can better protect the blood supply of the ureter and reduce the chance of urinary tract complications. This procedure is simple and easy to operate, and there is no risk of vesicoureteral reflux after transplantation. Even if anastomotic stenosis occurs after surgery, because the ureteral orifice has no anatomical changes, most of them can be effectively treated by endoscopic methods. The specific use of end-to-end or end-to-side anastomosis of the transplanted kidney ureter-autologous ureter is mainly determined by the recipient's urine volume before transplantation. It is generally believed that patients with urine output >300ml / 24h ua ntej hloov pauv yuav tsum siv qhov kawg-rau-sab anastomosis kom tsis txhob tshwm sim ntawm hydronephrosis tom qab hloov pauv.
Urinary fistula tom qab hloov lub raum
Qhov tshwm sim ntawm cov urinary fistula muaj feem xyuam rau cov ntshav ntawm tus neeg pub ureter, qhov ntev ntawm lub ureter, lub peev xwm ntawm cov ntaub so ntswg kho, theem ntawm hemoglobin, kev siv cov tshuaj hormones, thiab kab mob. Vim tias kev noj zaub mov tsis zoo ua ntej, cov neeg laus lub raum hloov pauv feem ntau cuam tshuam nrog ntshav qab zib mellitus, zais zis cov ntaub so ntswg, thiab tom qab noj tshuaj ntau dhau glucocorticoids, yog li qhov tshwm sim ntawm cov zis fistula ntau dua. Kev tuav tsis raug tuaj yeem ua rau poob ntawm lub raum hloov pauv thiab txawm tias tus neeg mob tuag.
Urinary fistula yog qhov yooj yim dua los kuaj xyuas. Cov kua dej ntau dhau los ntawm qhov txhab, thiab cov kua dej nyob ib ncig ntawm lub raum hloov pauv tau tsim. Cov qib creatinine ntawm cov kua dej tuaj yeem kuaj tau los ntawm kev kuaj xyuas cov qib creatinine hauv cov kua dej. Kev kuaj pom muaj peev xwm txheeb xyuas qhov chaw ntawm lub urinary fistula, uas tuaj yeem kho tau yooj yim lossis phais. Conservative kev kho mob muaj xws li lub qhov txhab kua, txaus tso zis catheter tso zis ntawm lub zais zis, ua kom lub zais zis khoob, thiab prolonging qhov chaw ntawm ureteral stents. Urinary fistula tom qab tshem tawm stent tuaj yeem txiav txim siab rau retrograde cystoscopic intubation. Rau lub zais zis fistula thiab me me fistulas tshwm sim los ntawm lax sutures, feem coob ntawm cov neeg mob tuaj yeem kho tau los ntawm kev saib xyuas kev kho mob, thaum lub urinary fistulas tshwm sim los ntawm ureteral necrosis, los yog kev kho mob ntawm lub raum pelvis thiab calyceal fistulas, kev kho mob feem ntau tsis zoo, thiab phais. yuav tsum tau kho lub sijhawm no. Cov txheej txheem tseem ceeb suav nrog kev hloov pauv ntawm lub raum thiab cov ureter nrog rau lub zais zis, hloov lub raum ureter-autologous ureter anastomosis, hloov lub raum pelvis-autologous ureter anastomosis, hloov lub raum pelvis los yog ureter-Boari leeg flap anastomosis, thiab lwm yam. mus rau lub zos adhesion thiab tus mob ntawm transplanted raum thiab ureter. . Txawm li cas los xij, kev kho kom zoo ntawm cov kab mob necrotic ureter kom ntseeg tau tias cov ntshav zoo thaum kawg ntawm lub ureter thiab tsis muaj qhov nro ntawm anastomosis yog tus yuam sij rau kev txhim kho cov zis fistula.
Hauv kev tiv thaiv thiab kev kho mob ntawm cov urinary fistula, peb qhov kev paub dhau los yog qhov ureteral vascular mov ntawm lub raum hloov pauv tsis zoo, thiab cov yam ntxwv lom neeg ntawm pedicled omentum nrog cov ntshav ncig, muaj zog nqus, thiab muaj zog tiv thaiv kab mob yog siv thaum lub sij hawm lub sij hawm. kev ua haujlwm. Kev qhwv lub ureteral anastomosis tuaj yeem tiv thaiv Urinary fistula, thiab tseem ua tiav cov txiaj ntsig zoo hauv kev kho cov zis fistula.
Vesicoureteral reflux tom qab hloov lub raum
Cov neeg laus uas muaj lub zais zis tsis ua haujlwm thiab qis qis qis ntawm cov kab mob sib txawv yog qhov ua rau vesicoureteral reflux. Kev kis tus kab mob rov qab tuaj yeem ua rau muaj kev cuam tshuam ntawm nephritis, lub raum fibrosis lig, thiab, hauv cov xwm txheej hnyav, kev ua haujlwm ntawm lub raum hloov pauv. Nws cov tsos mob tseem ceeb yog cov kab mob urinary recurrent, nrog los yog tsis mob nyob rau hauv lub transplanted raum cheeb tsam los yog lub plab mog thaum tso zis. Kev kuaj mob tuaj yeem lees paub los ntawm excretory cystourethrography, uas yog tshwm sim los ntawm reflux ntawm tus neeg sawv cev sib txawv rau lub ureter thaum tso zis, thiab nyob rau hauv cov mob hnyav, reflux rau lub raum pelvis thiab lub raum calyces.
Cov neeg mob uas mob reflux me ntsis yog kho nrog cov tshuaj tua kab mob hauv qhov ncauj los kho cov kab mob urinary; Cov neeg mob uas muaj mob reflux feem ntau xav tau kev phais, nrog rau kev txhaj tshuaj ureteral submucosal ntawm sclerotherapy thiab phais. Kev siv tshuaj tua hluav taws xob yog nrhiav tau qhov qhib ntawm lub raum ntawm lub raum ntawm lub cystoscope thiab txhaj cov khoom siv ntawm 4 submucosal cov ntsiab lus ntawm kev qhib lub tso zis. Tag nrho cov ntim feem ntau yog 0.2 ~ 0.5ml raws li qhov xwm txheej.
Tam sim no, feem ntau siv tshuaj txhaj tshuaj yog collagen, silica gel, thiab lwm yam, thiab cov txheej txheem yog lub cev puv. Txoj kev kho mob tsis tshua muaj kev cuam tshuam, yooj yim, thiab rov tsim dua, tab sis cov nyhuv ntev ntev tsis paub meej, uas yuav cuam tshuam nrog kev nqus los yog txav ntawm cov tshuaj, thiab tseem tuaj yeem ua rau ureteral obstruction. Cov kev qhib muaj xws li reimplantation ntawm lub raum transplanted, ureter, thiab zais zis, thiab anastomosis nrog lub autologous ureter.
Perioperative qis urinary tract obstruction nyob rau hauv cov neeg laus raum hloov pauv tau txais
Perioperative obstructive cov tsos mob ntawm benign prostatic hyperplasia nyob rau hauv cov laus txiv neej raum hloov cov neeg tau txais kev pab tsis yog ib qho yooj yim thiab yuav tsum tau ceev faj. Thaum muaj cov tsos mob tshwm sim, cov kev ntsuam xyuas cuam tshuam yuav tsum tau ua kom zoo dua kom paub meej tias qhov kev kuaj mob.
Cov neeg mob uas muaj benign prostatic hyperplasia ua ntej hloov pauv yuav tsum tau kho nrog tshuaj raws li kev kho mob niaj hnub, thiab kev ua haujlwm ntawm benign prostatic hyperplasia yuav tsum tau muab tso rau tom qab hloov pauv ntau li ntau tau. Yog hais tias lub prostate raug tshem tawm ua ntej hloov lub raum, lub zais zis caj dab contracture thiab urethral stenosis feem ntau tshwm sim los ntawm anuria los yog oliguria tom qab phais. Tsis tas li ntawd, coagulation dysfunction nyob rau hauv cov neeg laus cov neeg mob uas muaj uremia yuav ua rau kom tsis tu ncua tom qab los ntshav thiab ua rau muaj kev pheej hmoo ntawm kev phais.
Lub sijhawm ntawm postoperative prostatectomy feem ntau yog nyob ntawm tus neeg mob txoj kev rov qab los tom qab hloov lub raum. Vim tias feem ntau ntawm cov neeg mob no yog cov neeg laus, feem ntau nrog cov kab mob plawv thiab cov kab mob cerebrovascular, lawv muaj feem xyuam rau cov neeg mob uas muaj kev pheej hmoo siab prostatic hyperplasia, nquag los ntshav, kis kab mob, induced rejection, thiab lwm yam, thiab feem ntau tsis tuaj yeem zam kev phais qhib. Ntxiv mus, lub raum ureteral anastomosis yog nyob rau hauv lub zais zis Lateral anterior phab ntsa, suprapubic cystoprostatectomy yog ib qho yooj yim rau kev puas tsuaj rau lub anastomosis, yog li "ib nrab-TURP" yuav tsum yog thawj xaiv rau minimally invasive kev kho mob, uas yog, nws tsis yog yuav tsum tau kom tshem tawm tag nrho. cov qog hyperplastic, thiab lub sijhawm ua haujlwm, ntshav poob, thiab txo qis hauv kev ua haujlwm yog luv li sai tau. Qhov cuam tshuam ntawm cov kua dej lavage ntawm tus neeg mob lub circulatory system tuaj yeem zam qhov teeb meem loj tom qab phais thiab ua tiav cov txiaj ntsig zoo.
Hauv kev xaus, kev hloov pauv raum rau cov neeg laus tuaj yeem tiv thaiv tau cov teeb meem tom qab tso zis los ntawm kev xaiv ib txoj hauv kev tsim nyog ntawm kev tsim cov zis, txuas ntxiv txhim kho qhov tseeb ntawm kev hloov pauv, thiab tiv thaiv cov ntshav ntawm lub davhlau ya nyob twg ureter thaum lub raum sau thiab kho lub raum. Yog tias muaj teeb meem ntawm cov zis tshwm sim tom qab kev phais, qhov tshwm sim loj tuaj yeem zam tau los ntawm kev kuaj mob raws sij hawm thiab kho kom raug.
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