经皮顺行输尿管支架植入在移植肾输尿管梗阻中的应用11例

Percutaneous antegrade ureteral stent in the treatment of renal graft ureteral obstruction： 11 cases report

目的探讨经皮顺行输尿管支架植入治疗移植肾输尿管梗阻的有效性和安全性。方法2009年3月至2011年3月间11例肾移植输尿管梗阻患者，其中急性梗阻2例，慢性梗阻9例。11例梗阻的原因为移植肾输尿管膀胱吻合口狭窄5例，结石梗阻2例，原因不详4例。术前以超声评估移植肾及集合系统，选择合适穿刺部位，在X线透视下完成顺行肾盂和输尿管造影；明确梗阻位置后，通过穿刺针植入斑马导丝直至膀胱，再经膀胱镜从尿道引出斑马导丝，沿斑马导丝顺行植入输尿管支架管，X线下观察输尿管支架上端进入肾盂后，拔除斑马导丝，再次透视，确认支架管位置。移植肾肾盂造瘘管引流1～2周后拔除，输尿管支架在术后半年至1年内取出。在术后1周、1个月、3个月、6个月行B型超声及肾功能检查，之后每隔半年检查。结果11例中10例手术成功，1例因输尿管狭窄段过长置管失败。输尿管支架植入手术耗时为（54±27）min，患者血清肌酐由术前（326±147）μmol／L下降至术后（89±49）μmol／L。随访6～27个月，患者均未发生并发症。结论经皮顺行输尿管支架植入治疗移植肾输尿管梗阻是一种安全、有效的方法。

Objective To explore the efficacy and safety of percutaneous antegrade stenting in the treatment of ureteral obstruction after renal transplantation. Methods We retrospectively reviewed 11 patients with renal graft ureteral obstruction （2 cases of acute obstruction and 9 cases of chronic obstruction） from March 2009 to March 2011. The etiology of the obstruction was renal graft-ureterbladder anastomotic stricture in 5 cases, stone obstruction in 2 cases, and undetermined in 4 cases. Renal graft and collecting system were examined by ultrasonography preoperatively to select suitable puncture position, and then ureteropyelography was performed under X-ray guidance. When the obstruction location was clear, the urology guidewire was implanted to the bladder by needle, and then guidewire was released by cystoscopy. Ureteral stent was implanted along the guidewire, and upper ureteral stents was observed under X-ray. After removal of guidewire, the stent location was confirmed once again. The renal pelvis fistula drainage lasted for 1-2 weeks, and ureteral stent to 6 months to one year. Ultrasound and renal function were tested after 1 week, 1 month, 3 months and 6 months, and then every six months. Results Operation was done successfully in 10 patients, and failed in one case due to a long segment of ureteral stenosis. The operating time of ureteral stent implantation was 54 ± 27 rain. Serum creatinine of patients was reduced from preoperative 326± 147 to postoperative 89 ± 49 μmol/L. During a follow-up period of 6 to 27 months, no complications occurred. Conclusion Percutaneous antegrade stenting in the treatment of ureteral obstruction after renal transplantation is safe and effective.