肾移植术后输尿管梗阻的临床处理

Management of urinary obstruction following renal transplantation

目的探讨肾移植术后输尿管梗阻的诊断及处理对策。方法回顾总结2003～2006年该院收治的9例移植后出现输尿管梗阻的患者。其中移植肾输尿管结石3例,采用经皮肾镜下气压弹道碎石术;输尿管膀胱吻合口狭窄2例,经皮移植肾穿刺高压气囊扩张后放置D-J管,效果不满意,后1例采用钬激光行内切开,另1例改开放手术;移植肾肾盂输尿管连接部狭窄梗阻2例,输尿管末段坏死2例,均采用移植肾近端存活输尿管与自体输尿管端侧或端端吻合。结果9例肾移植术后出现输尿管梗阻的患者经手术均成功挽救移植肾功能。再次手术后随访0.5～3.0年,肾功能均正常,B超未见移植肾扩张积水。结论输尿管梗阻是肾移植术后常见亦是较为棘手的外科并发症,处理宜根据引起梗阻的原因采用相应的术式。

[Objective] To explore diagnosis and treatment of urinary obstruction involving the transplantation kidney. [Methods] A retrospective analysis was performed in 9 cases of urinary obstruction involving the transplanted kidney, including 3 cases of ureteral calculi, 2 vesicoureteral anastomotic stricture, 2 pyeloureteral junction stricture after transplantation, and 2 ureter necrosis. [Results] The renal function of the graft was preserved in all the other cases after endoscopic or open surgeries. In the follow-up for 0.5 to 3.0 years after the second surgery, without further renal enlargement or exacerbation of renal retention shown by B-mede ultrasonography. [ Conclusion] Urinary obstruction after renal transplantation is a difficult surgical complication, which can be managed by endoscopic or open surgeries depending on the causes of the obstruction.