移植肾输尿管梗阻的诊断与治疗(附13例报告)

Diagnosis and treatment of ureter obstruction after renal transplantation(Report of 13 cases)

为了提高对移植肾输尿管梗阻患者的诊断与治疗水平，对在536例次肾移植患者中发现的13例输尿管梗阻患者进行临床总结分析，其中输尿管狭窄性梗阻10例，输尿管结石性梗阻3例。分析认为，肾移植术后早期排斥反应、伤口深部感染及漏尿可能与发生移植肾输尿管狭窄性梗阻有关，而肾移植术后高尿酸血症与输尿管结石形成有关。提出B超、肾图、经皮顺行造影和肾益内压测定为诊断移植肾输尿管梗阻的手段；对于输尿管狭窄性梗阻患者，早期经皮穿刺造疾引流术是挽救患者肾功能的关键，肾功能恢复后应尽快行经皮输尿管扩张置管术；对于移植肾输尿管结石性梗阻患者以保守治疗为宜。

13 patients with ureter obstruction were diagnosed in 536 renal transplantation recipients. Of which 10 cases were with ureter stenosis and 3 cases with ureter stone. Most of the patients with ureter stenosis had early complications such as acute rejection,serious wound infection and urinary leakage. All patients with ureter stone had hyperuricemia. Main symptoms of ureter obstruction were similar to acute rejection. Although ultrasonic examination and radioisotopic renogram were primary diagnostic methods, but percutaneous pyelography in combination with pyelometry was necessary for confirmation of obstruction. The patients with ureter stenosis should be treated by percutaneous nephrostomy and continuous drainage to save renal function. The patients with ureter stone should be treated by conservative methods.