移植肾输尿管结石的治疗(附11例报告)  

Treatment of Ureteral Calculi in Allograft Kidneys:Report of 11 Cases

作　　者：周杰 包佑根[2] 朱遵伟[2] 朱心燊[2] 付冬辉 贾灵华[2] 王金根[2] 陈捷 Zhou Jie;Bao Yougen;Zhu Zunwei(不详;Department of Urology,Jiangxi Provincial People’s Hospital,First Affiliated Hospital of Nanchang Medical College,Nanchang 330006,China)

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科 [2]江西省人民医院,南昌医学院第一附属医院泌尿外科,南昌330006

出　　处：《中国微创外科杂志》2022年第9期733-738,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：江西省卫健委普通科研课题(20203076);江西省中医药管理局科研课题(2019B038)。

摘　　要：目的总结移植肾输尿管结石的治疗经验。方法2013年1月~2021年5月我院对11例移植肾输尿管结石行输尿管(软)镜碎石、经皮肾镜取石(percutaneous nephrolithotomy,PCNL)或体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL)治疗。结果4例输尿管上段结石,1例行积极监测及外院ESWL治疗;1例行输尿管镜碎石(ureteroscopic lithotripsy,URL)失败,改行肾造瘘(二期PCNL);2例行输尿管软镜碎石。7例输尿管下段结石,1例行ESWL 1次;2例行URL;1例合并移植肾输尿管口狭窄及肾结石,狭窄扩张后行URL和PCNL治疗;3例URL失败,除1例选择积极监测后失访外,余2例分别行输尿管切开取石和膀胱切开输尿管镜碎石。除1例失访外,余10例随访19~104个月,中位数43个月,均无残留结石,人肾均存活。结论移植肾输尿管结石的治疗应个体化,尽可能保护移植肾功能,积极监测、ESWL、PCNL和开放手术应谨慎选择,首选治疗为创伤小、并发症少的逆行输尿管(软)镜碎石,如需开放手术可考虑膀胱切开输尿管(软)镜碎石。Objective To summarize the experience of treatment of ureteral stones in allograft kidneys.Methods We retrospectively analyzed clinical data of 11 patients with transplanted renal ureteral stones treated with rigid or flexible ureteroscopic lithotripsy(URL),percutaneous nephrolithotomy(PCNL)or extracorporeal shock wave lithotripsy(ESWL)admitted to our hospital from January 2013 to May 2021.Results Of the 4 cases with proximal ureteral calculi,1 case received active surveillance and ESWL,1 case failed in ureteroscopy and was given nephrostomy(stageⅡPCNL),and the other 2 cases underwent retrograde flexible ureteroscopic lithotripsy.Of the 7 cases with distal ureteral calculi,1 case received ESWL once,2 cases underwent retrograde URL,1 case complicated with ureteral stricture and renal calculi was given URL and PCNL after stricture dilation,and ureteroscopy failed in 3 cases,1 of which lost follow-up after active surveillance and the remaining 2 of which underwent ureterolithotomy and cystotomy URL,respectively.Except for one lost case,the remaining 10 cases were followed up for 19-104 months,with a median of 43 months.No residual stones were found,and all the patients and transplanted kidneys survived well.Conclusions Treatment of ureteral calculi in allograft kidneys should be individualized,and renal allograft function should be protected as much as possible.Active surveillance,ESWL,PCNL and open surgery should be carefully selected.The preferred treatment is retrograde rigid or flexible URL,which has less trauma and fewer complications.If open surgery is needed,cystotomy rigid or flexible URL can be considered.

关 键 词：肾移植 输尿管结石 输尿管软镜 

分 类 号：R699[医药卫生—泌尿科学]