造血干细胞移植后输尿管狭窄1例  

Ureteral stenosis following hematopoietic stem cell transplantation:A case report

作　　者：韩冠鹏 许洋洋 李志华[1] 孟畅 朱宏建 杨昆霖 周利群[1] 李学松[1] HAN Guan-peng;XU Yang-yang;LI Zhi-hua;MENG Chang;ZHU Hong-jian;YANG Kun-lin;ZHOU Li-qun;LI Xue-song(Department of Urology,Peking University First Hospital,Institute of Urology,Peking University,National Urological Cancer Center,Beijing 100034,China;Department of Urology,Beijing Jiangong Hospital,Beijing 100054,China)

机构地区：[1]北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京100034 [2]北京市健宫医院泌尿外科,北京100054

出　　处：《北京大学学报（医学版）》2022年第4期762-765,共4页Journal of Peking University:Health Sciences

摘　　要：造血干细胞移植(hematopoietic stem cell transplantation,HSCT)是多种血液系统疾病的治疗方法,随着移植技术的进步和免疫抑制药物的发展,患者的生存期也有所延长。输尿管狭窄是HSCT的罕见并发症,临床常采用留置输尿管支架管、肾造瘘等方法治疗,影响患者生活质量。目前国内外鲜有外科手术治疗HSCT后输尿管狭窄的报道。北京大学第一医院2015年收治HSCT后输尿管狭窄1例,行回肠代输尿管术,术后长期随访,疗效满意,现报告如下。Ureteral stenosis is a comparatively rare complication following hematopoietic stem cell transplantation(HSCT). The etiology is still unclear and most believe that this may be due to the reactivation of BK virus in a state of immunodeficiency. In the later stages of ureteral stenosis with scarring, invasive interventions must be taken to relieve the hydronephrosis. Common treatments, such as D-J stent placement and permanent nephrostomy may not only entail the risk of infection, but also seriously affect the quality of life. Few cases of surgical intervention have been reported. In this article, a 25-year-old female was admitted to Peking University First Hospital suffering from recurrent flank pain. Seven years before, she developed hemorrhagic cystitis and bilateral urethritis 40 days after allogeneic HSCT. After continuous bladder irrigation and antiviral therapy, the left-sided hydronephrosis gradually alleviated while the right-sided one did not improve. D-J stents were used for urine drainage for 7 years before percuta-neous nephrostomy. Preoperative antegrade pyelography revealed significant hydronephrosis in the right kidney with long stricture of proximal-middle ureter. After comprehensive decision, she underwent ileal ureter replacement. The operation was successful. The segmental lesion was dissected and the scar tissue was removed. A 25 cm intestinal tube was isolated to connect the pelvis and bladder. An anti-reflux nipple was created at the distal end of ileal ureter to prevent the potential infection. The blood loss was minimal. After surgery, the drainage tube was removed in 2 weeks, the nephrostomy tube and the D-J stent was removed in 3 months. Follow-up mainly included clinical assessment, serologic testing, renal ultrasonography, blood gas analysis and radiological examination. During the follow-up of 6 years, she was symptom-free and no postoperative complications occurred. The serum creatinine level was stable. No hydronephrosis was observed under ultrasonography. Obvious peristaltic waves a

关 键 词：造血干细胞移植 输尿管狭窄 回肠代输尿管术 

分 类 号：R693.2[医药卫生—泌尿科学]