自体肾移植术治疗长段输尿管缺损10例报告  

Renal autotransplantation for the management of long segment ureteral defects：a report of 10 ca-ses

作　　者：刘斌[1] 卢峡[1] 施辉波[1] 蒋继贫[1] 曾凡军[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,武汉430030

出　　处：《临床外科杂志》2014年第8期589-591,共3页Journal of Clinical Surgery

摘　　要：目的：总结采用自体肾移植术治疗长段输尿管缺损的临床疗效和体会。方法对10例输尿管中上段结石患者，在经输尿管硬镜钬激光碎石时出现长段输尿管黏膜袖套状剥脱或全层撕脱，内镜下放置双 J 管失败，无法行输尿管端端吻合或再植，于损伤发生2 h 至9 d 后行自体肾移植术。结果1例术前肾功能严重减退患者术后7 d 出现移植肾栓塞，其余9例随访5～75个月，移植肾血流灌注良好，肾功能维持正常水平；1例术后4个月出现膀胱吻合口狭窄致自体移植肾中度积水，给予微创经皮肾穿刺造瘘引流；尿路感染1例，经抗感染治疗后好转，未见复发。结论针对医源性长段输尿管撕脱伤患者，及时施行自体肾移植可以有效恢复尿路完整性并保持肾功能，且并发症发生率低。Objective To summarize the clinical effects and experience of renal autotransplanta-tion for the management of long segment ureteral defects.Methods Ten patients suffering from middle and upper ureteral stones underwent transureteroscopic holmium laser lithotripsy and presented sleeve-like or full-thickness avulsions of the long segment ureteral membrane during the operation.Double-J stent was failed to place under the endoscope,end-to-end anastomosis or replantation of the ureter was inoperable and renal autotransplantation was adopted after 2 hours to 9 days.Results One patient with severe renal dysfunction had thrombosis of the transplanted kidney at the 7th day postoperatively.The other 9 cases were followed up for 5-75 months and the renal function was normal with good perfusion.One patient was found to have uretero-vesical anastomotic stenosis and hydronephrosis of the transplanted kidney at the 4th month after surgery,and minimally invasive percutaneous renal puncture was performed for fistulization and drainage.Urological infection occurred in one case and treated by antibiotics without any recurrence. Conclusion For patients with iatrogenic long segment ureteral avulsions,renal autotransplantation is ef-fective in restoring urinary tract integrity and renal function with acceptable morbidity.

关 键 词：自体肾移植 输尿管 长段缺损 

分 类 号：R692[医药卫生—泌尿科学]