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中华移植杂志(电子版)

中华移植杂志(电子版) ›› 2025, Vol. 19 ›› Issue (01) : 2 -8. doi: 10.3877/cma.j.issn.1674-3903.2025.01.001

儿童肾移植

合并膀胱功能障碍儿童肾移植受者疗效评估
孙瑜博1, 陈瑞2, 翟亦晖2, 汤梁峰1, 张致庆2, 王春燕2, 耿红全1, 沈茜2, 刘锋2, 徐虹2,†()   
  1. 1. 201102 上海,国家儿童医学中心 复旦大学附属儿科医院泌尿外科
    2. 肾脏科(肾移植科) 上海市肾脏发育和儿童肾脏病研究中心 肾脏疾病全国重点实验室
  • 收稿日期:2024-11-29 出版日期:2025-02-25
  • 通信作者: 徐虹
  • 基金资助:
    上海市科学技术委员会重大专项(2023SHZDZX02C09)

Evaluation of the therapeutic effect of pediatric kidney transplant recipients combined with bladder dysfunction

Yubo Sun1, Rui Chen2, Yihui Zhai2, Liangfeng Tang1, Zhiqing Zhang2, Chunyan Wang2, Hongquan Geng1, Qian Shen2, Feng Liu2, Hong Xu2,†()   

  1. 1. Department of Urology, Shanghai Kidney Development & Pediatric Kidney Disease Research Center, National Key Laboratory of Kidney Diseases, Children's Hospital of Fudan University,National Children's Medical Center, Shanghai 201102, China
    2. Department of Nephrology (Kidney Transplantation), Shanghai Kidney Development & Pediatric Kidney Disease Research Center, National Key Laboratory of Kidney Diseases, Children's Hospital of Fudan University,National Children's Medical Center, Shanghai 201102, China
  • Received:2024-11-29 Published:2025-02-25
  • Corresponding author: Hong Xu
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引用本文：

孙瑜博, 陈瑞, 翟亦晖, 汤梁峰, 张致庆, 王春燕, 耿红全, 沈茜, 刘锋, 徐虹. 合并膀胱功能障碍儿童肾移植受者疗效评估[J/OL]. 中华移植杂志(电子版), 2025, 19(01): 2-8.

Yubo Sun, Rui Chen, Yihui Zhai, Liangfeng Tang, Zhiqing Zhang, Chunyan Wang, Hongquan Geng, Qian Shen, Feng Liu, Hong Xu. Evaluation of the therapeutic effect of pediatric kidney transplant recipients combined with bladder dysfunction[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2025, 19(01): 2-8.

目的

评价合并膀胱功能障碍的儿童肾移植受者术后疗效。

方法

回顾性分析2022年12月1日至2024年7月15日在复旦大学附属儿科医院接受肾移植手术的儿童受者临床资料。合并神经源性膀胱、后尿道瓣膜等引起膀胱功能障碍的患儿纳入病例组(n=8),未合并膀胱功能障碍的患儿纳入对照组(n=97)。比较两组患儿基本信息、手术和住院时长以及术后移植肾功能延迟恢复(DGF)、急性排斥反应、尿路感染、移植肾积水和输尿管膀胱吻合口梗阻情况、患儿和移植肾存活率。评估病例组患儿肾移植前膀胱功能障碍和术后随访情况。非正态分布计量资料组间比较采用Mann-Whitney U检验,计数资料组间比较采用Fisher确切概率法,P＜0.05为差异有统计学意义。

结果

8例病例组患儿中3例为神经源性膀胱,5例为后尿道瓣膜。随访至2025年2月,病例组和对照组中位随访时间分别为417(291,543)d、434(295,670)d。病例组8例患儿和移植肾均存活；对照组97例患儿均存活,5例移植肾功能丢失。病例组和对照组患儿、移植肾存活率差异均无统计学意义(χ2=0.00和0.43,P均＞0.05)。病例组患儿术后尿路感染发生比例(6/8)高于对照组(8/97),差异有统计学意义(P＜0.001)。病例组患儿术后均未发生吻合口梗阻等外科并发症,对照组4例患儿术后拔除双J管后因输尿管膀胱吻合口梗阻再手术。病例组和对照组患儿手术时长、住院时长、DGF、急性排斥反应、拔除双J管后移植肾积水以及输尿管膀胱吻合口梗阻再手术发生情况差异均无统计学意义(P均＞0.05)。

结论

合并膀胱功能障碍的儿童肾移植受者疗效满意,但术后尿路感染发生比例较高。

关键词: 儿童肾移植, 膀胱功能障碍, 神经源性膀胱, 后尿道瓣膜

Objective

To evaluate the efficacy in pediatric kidney transplant recipients combined with bladder dysfunction.

Methods

Retroactively review the clinical data of pediatric recipients who underwent kidney transplantation operation at the Children's Hospital of Fudan University from December 1, 2022 to July 15th, 2024. Children with bladder dysfunction (neurogenic bladder and posterior urethral valve) were included in the case group (n=8), while those without bladder dysfunction were included in the control group (n=97). Collect data and compare the basic information, surgical and hospitalization duration, as well as the incidence of delayed graft function(DGF), acute rejection, urinary tract infection, hydronephrosis of the transplanted kidney, and ureterovesical anastomotic obstruction after transplantation between the two groups. The survival rates of the children and the transplanted kidneys were also compared. The preoperative bladder dysfunction and postoperative follow-up of the children in the case group were evaluated. The Mann-Whitney U test was used for inter group comparison of non-normal distribution quantitative data, and Fisher's exact probability method was used for inter group comparison of count data. P value ＜0.05 was considered statistically significant.

Results

Among the 8 cases in the case group, 3 cases were neurogenic bladder and 5 cases were posterior urethral valve. The average follow-up time for the case group and the control group until February 2025 was 417(291, 543) days and 434(295, 670) days, respectively.8 cases of pediatric patients and transplanted kidneys in the case group all survived； All 97 children in the control group survived, while 5 cases experienced loss of transplanted kidney function. There was no statistically significant difference in the survival rate of pediatric patients and transplanted kidneys between the case group and the control group (χ2=0.00 and 0.43, all P＞0.05). The incidence of postoperative urinary tract infection in the case group (6/8) was higher than that in the control group(8/97), and the difference was statistically significant (P＜0.001). None of the patients in the case group experienced surgical complications such as anastomotic obstruction after surgery, while the 4 patients in the control group underwent reoperation due to ureteral and bladder anastomotic obstruction after removing the double-J tube. There were no statistically significant difference in surgical duration,hospitalization duration, DGF and acute rejection of transplanted kidneys, transplanted kidney hydronephrosis, and reoperation for anastomotic obstruction between the case and the control groups (all P＞0.05).

Conclusions

The herapeutic effect in pediatric kidney transplant patients combined with bladder dysfunction is satisfactory, but the incidence of postoperative urinary tract infection is relatively high.

Key words: Pediatric kidney transplantation, Bladder dysfunction, Neurogenic bladder, Posterior urethral valve
表1 病例组和对照组患儿术前一般资料比较
组别 例数 年龄[d,M（P25，P75）] 性别(例,男/ 女) 尿量[mL/ d,M（P25，P75）] 透析(例,是/ 否) 血清肌酐[μmol/ L,M（P25，P75）]
病例组 8 4 891(3 408,5 540) 6/ 2 1 050(600,1 938) 5/ 3 531. 0(505. 5,631. 0)
对照组 97 3 844(2 911,4 802) 54/43 600(200,1 100) 75/22 637. 0(513. 0,902. 0)
Z值 - 1. 61 - 1. 93 - -1. 18
P值 - ＞0. 05 0. 46a ＞0. 05 0. 39a ＞0. 05
表2 病例组和对照组患儿观察指标比较
组别 例数 手术时长[h,M（P25，P75）] 住院天数[d,M（P25，P75）] 移植肾功能延迟恢复(例) 急性排斥反应(例) 术后尿路感染(例)
病例组 8 2. 8(2. 4,4. 4) 18. 8(13. 4,50. 0) 2 1 6
对照组 97 2. 6(2. 3,2. 9) 19. 0(14. 5,30. 0) 15 4 8
Z值 - 1. 12 0. 05 - - -
P值 - ＞0. 05 ＞0. 05 0. 61a 0. 33a ＜0. 001a
组别 例数 拔除双J 管后移植肾积水(例)b 输尿管膀胱吻合口梗阻再手术(例)
拔除后2 d 拔除后3 个月 拔除后6 个月
病例组 8 2 2 1 0
对照组 97 35 11 9 4
Z值 - - - - -
P值 - 0. 71a 0. 26a 0. 56a 1. 00a
表3 病例组患儿肾移植前膀胱功能障碍评估
病例 性别 年龄(d) 原发病 既往手术史 症状 既往尿路感染 尿控方式 VCUG 尿动力学检查
1 女 4 931 神经源性膀胱 骶尾部脂肪瘤切除术、栓系松解术 两便困难、反复尿路感染 有 CIC 膀胱毛糙,左1 级反流 容量246 mL,顺应性9. 8 cmH2O
2 女 5 631 神经源性膀胱 脊髓脊膜膨出修补术、栓系松解术 两便失禁 无 CIC 膀胱不规则增厚,左4 级、右1 级反流 容量90 mL,顺应性2. 1 cmH2O
3 男 4 584 后尿道瓣膜 后尿道瓣膜切开、输尿管再植术 尿路感染 有 自主排尿 膀胱、尿道形态失常,不光整 容量618 mL,顺应性＞20 cmH2O
4 男 6 121 非神经源性神经源性膀胱 无 无 无 自主排尿 多发憩室、小梁形成 容量423 mL,顺应性＞20 cmH2O,最大尿流率15 mL/ s
5 男 3 416 后尿道瓣膜 后尿道瓣膜切开术 排尿困难、反复尿路感染 有 CIC 膀胱毛糙,形态失常,多发憩室、尿道局部狭窄 容量146 mL,顺应性6. 7 cmH2O,最大尿流率1 mL/ s,大量残余尿
6 男 2 279 后尿道瓣膜 后尿道瓣膜切开术、膀胱造口术、输尿管造口术 反复尿路感染 有 输尿管造口 膀胱造口,容量极小(15 mL),双侧1 级反流 未检查
7 男 5 267 后尿道瓣膜 后尿道瓣膜切开术 排尿滴沥、尿线细 有 自主排尿 膀胱毛糙, 双侧4 级反流 容量276 mL,顺应性＞20 cmH2O,最大尿流率1 mL/ s,大量残余尿
8 男 4 851 后尿道瓣膜 后尿道瓣膜切开术、输尿管再植术 排尿困难、反复尿路感染 有 CIC 膀胱不规则,左侧4 级反流 容量350 mL,顺应性＞20 cmH2O,最大尿流率5 mL/ s,大量残余尿
表4 病例组患儿肾移植后随访情况
病例 术后尿控 末次随访距手术时长(d) 术后尿路感染 末次随访血清肌酐(μmol/ L) 末次随访超声APD(mm) 末次随访尿动力学检查
1 CIC 670 有 76. 0 0 容量194 mL,顺应性11. 2 cmH2O
2 CIC 685 有 79. 2 0 容量113 mL,顺应性5. 4 cmH2O
3 自主 416 无 86. 3 0 容量457 mL,顺应性＞20 cmH2O
4 CIC 396 有 134. 1 0 容量475 mL,顺应性＞20 cmH2O,最大尿流率16 mL/ s
5 CIC 377 有 57. 5 6. 2 容量200 mL,顺应性6. 7 cmH2O,大量残余尿
6 膀胱造口 383 有 64. 2 0 未检查
7 CIC 204 有 58. 9 0 容量274 mL,顺应性＞20 cmH2O
8 CIC 202 无 199. 3 0 容量400 mL,顺应性17. 6 cmH2O
1
Wu CQ, Franco I. Management of vesicoureteral reflux in neurogenic bladder[J]. Investig Clin Urol, 2017, 58(Suppl 1)：S54-S58.
2
Morioka A, Miyano T, Ando K, et al. Management of vesicoureteral reflux secondary to neurogenic bladder[J]. Pediatr Surg Int, 1998,13(8)：584-586.
3
Al-Qaoud TM, Al-Adra DP, Mezrich JD, et al. Complex ureteral reconstruction in kidney transplantation[J]. Exp Clin Transplant,2021, 19(5)：425-433.
4
Flegar L, Huber J, Putz J, et al. Multicenter evaluation of complex urinary diversion for renal transplantation： outcomes of complex surgical solutions[J]. World J Urol, 2024, 42(1)：239.
5
Aikawa A, Muramatsu M, Takahashi Y, et al. Surgical challenge in pediatric kidney transplant： lower urinary tract abnormality[J]. Exp Clin Transplant, 2018, 16(Suppl 1)：20-24.
6
中华医学会小儿外科学分会泌尿外科学组. 儿童后尿道瓣膜症诊疗的专家共识[J]. 中华小儿外科杂志, 2021, 42(7)：577-582.
7
文建国, 李云龙, 袁继炎, 等. 小儿神经源性膀胱诊断和治疗指南[J]. 中华小儿外科杂志, 2015, 36(3)：163-169.
8
Brownrigg N, Lorenzo AJ, Rickard M, et al. The urological evaluation and management of neurogenic bladder in children and adolescents-what every pediatric nephrologist needs to know[J].Pediatr Nephrol, 2024, 39(2)：409-421.
9
中华医学会器官移植学分会. 中国儿童肾脏移植等待者评估与管理临床诊疗指南[J]. 中华器官移植杂志, 2025, 46(1)：1-25.
10
Nahas WC, David-Neto E. Strategies to treat children with end-stage renal dysfunction and severe lower urinary tract anomalies for receiving a kidney transplant[J]. Pediatr Transplant, 2009, 13(5)：524-535.
11
Mariotto A, Cserni T, Marei Marei M, et al. Bladder salvage in children with congenital lower urinary tract malformations undergoing renal transplant[J]. J Pediatr Urol, 2023, 19(4)：401.e1-401.e7.
12
Fine MS, Smith KM, Shrivastava D, et al. Posterior urethral valve treatments and outcomes in children receiving kidney transplants[J].J Urol, 2011, 185(6 Suppl)：2507-2511.
13
Kamal MM, El-Hefnawy AS, Soliman S, et al. Impact of posterior urethral valves on pediatric renal transplantation： a single-center comparative study of 297 cases[J]. Pediatr Transplant, 2011, 15(5)：482-487.
14
McKay AM, Kim S, Kennedy SE. Long-term outcome of kidney transplantation in patients with congenital anomalies of the kidney and urinary tract[J]. Pediatr Nephrol, 2019, 34(11)：2409-2415.
15
Nahas WC, Antonopoulos IM, Piovesan AC, et al. Comparison of renal transplantation outcomes in children with and without bladder dysfunction. A customized approach equals the difference[J]. J Urol, 2008, 179(2)：712-716.
16
Marchal S, Kalfa N, Iborra F, et al. Long-term outcome of renal transplantation in patients with congenital lower urinary tract malformations： a multicenter study[J]. Transplantation, 2020, 104(1)：165-171.
17
Broniszczak D, Ismail H, Nachulewicz P, et al. Kidney transplantation in children with bladder augmentation or ileal conduit diversion[J].Eur J Pediatr Surg, 2010, 20(1)：5-10.
18
Basiri A, Otookesh H, Hosseini R, et al. Kidney transplantation before or after augmentation cystoplasty in children with high-pressure neurogenic bladder[J]. BJU Int, 2009, 103(1)：86-88； discussion 88.
19
Teng L, Wang C, Li J. Long-term outcome of simultaneous or staged urinary diversion and kidney transplantation[J]. Urol Int, 2013, 91(3)：310-314.
20
Capozza N, Torino G, Collura G, et al. Renal transplantation in patients with "valve bladder"： is bladder augmentation necessary?[J].Transplant Proc, 2010, 42(4)：1069-1073.
21
王长希, 刘龙山, 陈立中, 等. 合并严重下尿路异常者的肾移植及尿路处理八例[J]. 中华器官移植杂志, 2008, 29(1)：11-13.
22
邱江, 陈立中, 王长希, 等. 肾移植及回肠代膀胱术治疗神经原性膀胱伴尿毒症二例报告[J]. 中华泌尿外科杂志, 2005, 26(10)：711.
23
蒋亚梅, 宋涂润, 王显丁, 等. 肾移植及肠道膀胱扩大术治疗神经源性膀胱伴尿毒症二例[J]. 中华器官移植杂志, 2018, 39(10)：632-635.
24
Jung J, Mandal S, Groeben C, et al. Renal transplantation with triple ureter implantation into the urinary bladder after dissolving a bilateral ureterocutaneostomy for posterior urethral valves[J]. Urol Int, 2024, 28：1-9.
25
Rickard M, Chua ME, Zu'bi F, et al. Comparative outcome analysis of pediatric kidney transplant in posterior urethral valves children with or without pretransplant Mitrofanoff procedure[J]. Pediatr Transplant,2020, 24(8)：e13798.
26
Amesty MV, García-Vaz C, Espinosa L, et al. Long-term renal transplant outcome in patients with posterior urethral valves.Prognostic factors related to bladder dysfunction management[J].Front Pediatr, 2021, 9：646923.
27
Gnech M, van Uitert A, Kennedy U, et al. European Association of Urology/European Society for Paediatric Urology Guidelines on paediatric urology： summary of the 2024 updates[J]. Eur Urol,2024, 86(5)：447-456.
28
中华医学会小儿外科学分会小儿尿动力和盆底学组. 儿童清洁间歇导尿术中国专家共识[J]. 中华医学杂志, 2022, 102(34)：2669-2678.
29
中华医学会器官移植学分会,中国医师协会器官移植医师分会.中国儿童肾移植临床诊疗指南(2015版)[J/CD]. 中华移植杂志：电子版, 2016, 10(1)：12-23.
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