移植肾输尿管梗阻11例分析  

Prevention and Therapy of Ureteral Obstruction after Renal Transplantation

作　　者：王贵国[1] 陈世伟[1] 赵轶[1] 陈国宁[1] 陶鑫[1] 

机构地区：[1]解放军第174医院泌尿外科,福建厦门361003

出　　处：《临床军医杂志》2004年第4期57-59,共3页Clinical Journal of Medical Officers

摘　　要：目的　总结移植肾输尿管梗阻的防治经验。方法　对 1994— 2 0 0 3年 ,完成的 198例同种异体肾移植术后出现的 11例输尿管梗阻进行回顾分析。结果　 5 4例移植肾输尿管内放置双J管 ,只有 1例出现慢性输尿管远端狭窄 ,发生率 1.85 %,其余 14 4例中有 10例出现梗阻 ,发生率 6.94%。 5例急性梗阻患者均没有放置双J管 ,2例因髂窝血肿压迫者行血肿清除术 ;2例漏尿造成炎性水肿所致 ,行输尿管再植 ;1例结石者经解痉、中成药排石等非手术处理 ,结石排出。 6例慢性梗阻患者中 5例没有放置双J管 ,4例输尿管远端狭窄 ,行输尿管再植术 ;2例输尿管中、远段狭窄 ,行自身输尿管与移植肾肾盂吻合术。结论　 ( 1)放置双J管可以有效预防输尿管梗阻的发生 ;( 2 )移植肾输尿管梗阻经及时恰当的外科处理 ,疗效满意 ,对慢性梗阻患者 ,应根据术中输尿管探查情况 。Objective To sum up the preventive experiences of ureteral obstruction after renal transplantation. Methods During 1994—2003,198 cases of xenoma renal transplantation were performed, and 11 cases of ureteral obstruction occurred after operation.The above materials were retrospectively analized.Results In 54 cases of renal transplantation, double J catheters were implanted in ureter, and chronic distal ureteral stenosis occurred in only 1 case,the incidence was 1.85%,and in other 144 cases,there were 10 cases of obstruction,the incidence was 6.94%.Double J catheters were not implanted in ureter of 5 cases of acute ureteral obstruction,the operation of hematoma clearing were performed in 2 cases because of iliac fossa hematoma;ureter reimplantation were performed in 2 cases because of edema due to leakage of urine;in 1case of concretion, the concretion was removed through spasmolytic and the traditional Chinese medicine.Double J catheters were not implanted in 5 cases ureter of 6 chronic ureteral obstruction cases, and ureter reimplantation were performed in 4 cases because of chronic distal ureteral stenosis.Middle and distal ureteral stenosis occurred in 2 cases, and anastomosis of auto-ureter with pelvis of donor kidney were performed.1 case was cured by non operative treatment, and in other 10 cases, the renal function were improved significantly through suitable surgical management, and six month follow up showed no recurrence in all the cases. Conclusion (1) The ureteral stenosis could be prevented effectively by double J catheter implantation;(2) Ureteral obstruction following kidney transplantation could be treated by suitable surgical management,and for chronic ureteral obstruction cases,which ureter reimplantation or anastomosis of auto ureter with pelvis of donor kidney should be performed,were according to the ureter condion in the operation.

关 键 词：肾移植 输尿管梗阻 再植术 

分 类 号：R692[医药卫生—泌尿科学] R693[医药卫生—外科学]