肾移植术后输尿管梗阻的原因及对策

Etiology and strategy of ureteral obstruction following renal transplantation

目的分析肾移植术后输尿管梗阻的发病原因，总结预防和治疗的经验。方法回顾性分析近10年来21例肾移植术后输尿管梗阻的临床资料，所有受者均经过影像学检查并结合临床表现得到确诊。有14例行开放性手术治疗，7例行微创经皮肾造瘘输尿管镜下球囊扩张术治疗。结果梗阻原因主要有：输尿管膀胱吻合口或输尿管狭窄、输尿管扭曲或受压、感染及输尿管内小结石或血块堵塞等。14例经开放性手术治疗的受者中有11例术后症状缓解；另7例经微创手术后恢复良好。结论肾移植术后输尿管梗阻的发病原因复杂，预防尤为重要；确诊需结合影像学检查和临床表现；积极的外科手术是主要治疗手段。

Objective To investigate the etiological factors and treatment stragety of ureteral obstruction following renal transplantation and improve the prognosis. Methods Twenty-one patients with ureteral obstruction following renal transplantation in our hospital within 10 years were retrospectively analyzed. All patients were diagnosed by the clinical manifestations as well as various imaging examinations. Fourteen patients experienced open surgery and the latest 7 received percutaneous ureterorenoscope （PN） treatment. Results The causes of ureteral obstruction following renal transplantation were confirmed by surgery or histological examination, including ureterovesical anastomotic or ureteral stenosis, twisted ureter, intra-ureter microlith or blood clot and so on. Of 14 patients who underwent open surgery, 11 had a reduction in hydronephrosis. Seven patients who experienced minireally invasive endoscopic treatment recovered smoothly. Conclusions The etiological factors of ureteral obstruction following renal transplantation are various and complicated. The imaging examination and clinical manifestation are necessary for diagnosis. PN plays an important role in diagnosis and treatment. Active surgical treatment, including the minimally invasive endoscopic procedure, is main resort to improve the prognosis.