肾移植后输尿管梗阻的诊断和手术处理15例  

Clinical diagnosis and surgical management of ureteral obstruction after renal transplantation

作　　者：张清[1] 苏泽轩[1] 陈洁[1] 丁泓文[1] 刘一帆[1] 都兴华[1] 石利平[1] 

机构地区：[1]暨南大学附属第一医院泌尿外科,广州510630

出　　处：《中华器官移植杂志》2013年第9期542-544,共3页Chinese Journal of Organ Transplantation

基　　金：国家高科技研究发展计划（863计划）（2007AA02006）;广东省“十二五”医学重点学科基金（2012粤卫函20号）

摘　　要：目的探讨肾移植后输尿管梗阻的诊断和手术处理方法。方法回顾性分析2002年1月至2011年6月间肾移植后并发移植肾输尿管梗阻15例的资料，其中输尿管膀胱吻合口狭窄5例，输尿管下段狭窄4例，血凝块梗阻2例，输尿管下段穿孔炎症致输尿管水肿梗阻2例，移植肾输尿管结石1例，输尿管外血肿压迫1例。14例行开放手术恢复尿路通畅，1例行输尿管顺行球囊扩张＋双J管植入术。结果15例经彩色超声和（或）磁共振水成像诊断。受者在尿路重建及经腔镜顺行球囊扩张后梗阻症状完全缓解，肾功能恢复良好，也无相关并发症，随访1年未再发输尿管梗阻。结论肾移植后的输尿管梗阻可通过彩色超声和（或）磁共振水成像诊断，早期诊断和及时处理非常重要；开放性手术尿路重建是一种有效的方法，顺行球囊扩张治疗输尿管梗阻也是可行的。Objective To investigate the diagnosis and surgical management of ureteral obstruction after renal transplantatiorL Method A respective study was performed on 15 cases of ureteral obstruction who received renal allografts. All of the cases were confirmed, including 5 cases of stenosis of ureterovesical junction, 4 cases of stenosis of distal ureter, 2 cases of blood clot blockage, 2 cases of edema due to perforation of distal ureter, l case of ureteral calculi, and l case of extrinsic compression of hematoma. All 14 patients underwent open surgical management to re establish ureter with D-J catheter as stent for 12-16 weeks. One patient was subjected to percutaneous nephrostomy followed by percutaneous ureteroscopy, the obstructed site was identified at ureterovesical junction and antegrade balloon dilation and DJ stent in ureter were performed subsequently. Result Fifteen patients were diagnosed as ureteral obstruction by colour Doppler ultrasound and MRU. All of the patients were resolved the obstructions after surgical managements and the renal function got improved. No reobstruction occured during one-year follow-up period. Conclusion Colour Doppler ultrasound and MRU can definitely be used to diagnose ureteral obstruction after renal transplantation. Early diagnosis and surgical management are very important. Open surgical management of the obstructed ureter is an effective method. Antigrade balloon dilation is a therapeutic approach to treat ureteral obstruction.

关 键 词：肾移植 输尿管梗阻 外科手术 球囊扩张 

分 类 号：R699.2[医药卫生—泌尿科学]