移植肾输尿管梗阻的原因与处理方法

Clinical Analysis of 29 Ureteral Obstruction after Renal Transplantation

目的:探讨移植肾输尿管梗阻的发病原因及其处理方法。方法:报告行肾移植后发生移植肾输尿管梗阻29例的临床资料。全部经手术探查证实,包括输尿管膀胱吻合口狭窄9例,输尿管下段狭窄5例,输尿管全段闭锁2例,膀胱肌层包埋过紧1例,输尿管下段穿孔4例,输尿管全段坏死2例,输尿管下段血块堵塞1例,输尿管外周血肿压迫2例,脓肿压迫1例,移植肾输尿管结石2例。14例移植输尿管坏死患者中有10例梗阻前发生急性排斥反应。结果:患者尿路重建后移植肾功能均恢复良好,随访1年均无再次梗阻发生。结论:移植肾输尿管梗阻以输尿管狭窄和坏死最为多见,排斥反应是发生输尿管梗阻的重要病因之一。对于影像学提示梗阻而移植肾功能无明显受损的病例,应积极行移植肾活检。手术是解决移植肾输尿管梗阻最有效的方法。

Objeetive：To investigate the the mechanism,diagnosis and management of ureteral obstruction after renal transplantation. Methods： A retrospective study was performed on 29 graft ureteral obstruction cases who received renal allografts. All of the cases were confirmed by surgery,including 9 cases for stenosis of ureterovesical junction,5 cases for stenosis of distal ureter,2 cases for the atresia of the whole ureter, 1 case for over tightness of submucosal tunnel, 4 cases for perforation of distal ureter,2 cases for necrosis of the whole ureter, 1 case for blood clot blockage,2 cases for extrinsic compression of cyst and hematoma, 1 case for extrinsic compression of abscess, 2 cases for ureteral calculi. Graft reiection were experienced before obstruction in 10 cases. Results： All of the grafts retrieved good function beyond the reconstructing urinary drainage. No complication and reobstruction occurred after 1-year follow-up. Conclusions.. Graft rejection is one of the most significant reason for ureteral obstruction after renal transplantation. Graft biopsy should be taken for the cases of obstruction which was diagnosed according to radiology without impairment of graft function. Surgery was the most effective method to solve the obstruction.