肾移植后46例输尿管梗阻的超声诊断

Ultrasonic diagnosis of ureter obstruction after renal transplantation

背景:输尿管梗阻是肾移植后常见的并发症之一,影响肾小球滤过和肾小管的重吸收,损害肾功能。超声检查可见肾盂积水和梗阻部位以上输尿管扩张,可以明确梗阻的部位和原因。目的:评估二维超声对肾移植后输尿管梗阻的诊断价值。设计、时间及地点:病例分析,于2004-01/2008-05在华中科技大学同济医学院附属协和医院和武汉市三医院完成。对象:收集同种异体肾移植后患者的临床资料,其中二维超声诊断为移植肾输尿管梗阻患者46例,占同期肾移植患者的3%。方法:运用二维超声经腹壁对肾移植后肾输尿管梗阻患者进行检查;对于肾盂扩张积水者,换用高频探头动态扫描输尿管管壁及管腔。主要观察指标:二维超声对肾移植后肾输尿管梗阻患者的诊断结果。结果:①肾移植术后输尿管梗阻46例中狭窄性梗阻28例,结石性梗阻16例,外压性梗阻2例。②结石性梗阻于输尿管管腔内显示强回声,较大者伴声影;狭窄性梗阻者管壁及吻合口明显增厚,模糊不清;外压性梗阻输尿管上中段扩张,肾周巨大淋巴囊肿。结论:二维超声诊断是目前检查移植肾输尿管梗阻的主要方法,对结石性和外压性梗阻可明确诊断,对狭窄性梗阻初步诊断后需结合其他手段确诊。

BACKGROUND： Ureter obstruction is one of the common complications after renal transplantation, and it can influence glomerular filtration and tubular reabsorption and damage renal function. Ultrasonography shows hydronephrosis and ureterectasis above obstruction, and can identify the sites and causes of obstruction. OBJECTIVE： To investigate the diagnostic value of 2-dimentional ultrasonography for ureter obstruction after renal transplantation. DESIGN, TIME AND SETTING： Case analysis was conducted between January 2004 and May 2008 at the Third Hospital of Wuhan（Wuhan, Hubei Province, China） and the Affiliated Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology（Wuhan, Hubei Province, China）. PARTICIPANTS： Collecting clinical data of patients with allogeneic kidney transplantation, including 46 patients, accounted for 3% of all, with ureter obstruction of transplanted kidney diagnosed by 2-dimensional ultrasonography. METHODS： Patients with renal transplantation were examined by transabdominal 2-dimensional ultrasound, and the patients with hydronephrosis were examined by high frequency probe to observe the lumen and wall of the ureter dynamically. MAIN OUTCOME MEASURES： Diagnostic results of 2-dimensional ultrasound of patients with ureter obstruction after renal transplantation. RESULTS： In the forty-six patients with ureter obstruction after renal transplantation, 28 were due to ureter stenosis, 16 were due to stone and 2 were due to outside press. Those due to stone displayed strong echoes in ureteral lumen, the larger stone would accompany acoustic shadow; those due to stenosis had obviously thicker anastomotic stoma and tube wall, those due to outside press had ureterectasis of upper and middle ureter and giant perirenal lymphocysts. CONCLUSION： 2-dimensional ultrasonography is currently the main method to examine ureter obstruction after renal transplantation, it can definitely diagnose the obstruction caused by stone and outside press, and with other diagnostic methods can also diagnose the obstruction due to stenosis.