十年同一单位1160例肾移植输尿管并发症23例回顾性分析

A retrospective analysis of 23 out of 1 160 cases with ureteral complications following renal transplantation from the same center within ten years

背景：输尿管梗阻的发生原因有外科技术性、缺血性、周围病变压迫和排斥反应等,其中外科因素最为重要。如何有效降低肾移植后输尿管并发症的发生,并对其作出及时诊断、处理对临床有重要的指导意义。目的：回顾解放军济南军区总医院23例肾移植后输尿管并发症的诊治情况,分析总结肾移植后输尿管并发症的发病原因及防治经验。方法：回顾分析解放军济南军区总医院1998-01/2008-12肾移植患者1160例的临床资料,肾移植后发生输尿管并发症23例,占1.98%。其中尸体供肾移植共924例,发生移植肾输尿管并发症18例,占1.95%;活体供肾移植236例,发生移植肾输尿管并发症5例,占2.12%。17例行移植肾输尿管膀胱重新吻合术;2例行移植肾输尿管-自体输尿管吻合术;1例行输尿管皮肤造瘘术;1例行移植肾输尿管游离,重新放置输尿管支架管;1例行球囊扩张术;1例行软膀胱镜下逆行输尿管支架管插管治疗。输尿管并发症治疗后复查B超明确肾盂输尿管扩张恢复情况。结果与结论：23例患者中19例为输尿管膀胱吻合口狭窄,2例输尿管坏死,2例输尿管扭曲。治疗后随访3~98个月,其中20例患者经手术治疗,恢复了移植肾肾盂与膀胱的通畅,移植肾功能均有明显的改善,术后4d内血肌酐浓度下降,术后无复发。1例皮肤造瘘患者术后8年余,移植肾功能正常,定期更换造瘘管。1例扩张及1例留置输尿管支架管患者治疗后效果欠佳,仍输尿管狭窄,后行手术治疗。提示肾移植后输尿管梗阻病因复杂,以输尿管膀胱吻合口狭窄最常见;外科手术是解除梗阻的主要方法,经及时恰当的外科处理,对移植肾功能的恢复及长期存活无明显影响。

BACKGROUND：Ureteral obstruction is mainly caused by surgical technic,ischemic,and peripheral lesion compression as well as rejection;in particular,the surgical technic factor is the most important.How to effectively reduce ureteral complications following renal transplantation is significant for prompt diagnosis and clinical treatment.OBJECTIVE：To retrospectively analyze the diagnosis of 23 cases with ureteral complications following renal transplantation,and to summarize pathogeny and preventing management.METHODS：The retrospective analysis was conducted on 23（1.98%）out of 1 160 cases with ureteral complications following renal transplantation who were selected from General Hospital of Jinan Military Area Command of Chinese PLA from January 1998 to December 2008.In 924 cases of renal transplantation with cadaver kidneys,ureteral stenosis occurred in 18 cases（1.95%）,while in 236 cases with relative kidneys,ureteral stenosis occurred in 5 cases（2.12%）.A total of 17 cases were performed with ureterovesicostomy;2 with uretero-autoallergic anastomosis of ureter;1 with cutaneous ureterostomy;1 with ureteral liberation,resetting ureteric branch stand;1 with saccule dilation;1 with retrograde ureteric branch stand under cystoscope.Type-B ultrasonic examination was re-checked to determine pyeloureterectasis following treating ureteral complications.RESULTS AND CONCLUSION：Of the 23 cases,stenosis of ureterovesical junction occurred in 19 cases,necrosis of the ureter on 2 cases,and twisting of ureter graft on 2 cases.Following up was performed after treatment for 3-98 months.In 20 cases,renal pelvis and urinary bladder of transplanted kidney were smooth,and function was recovered remarkably.At 4 days after surgery,serum creatinine level was decreased,and no recurrence was rechecked postoperatively.One patient had skin stoma for 8 years at least postoperatively,and the renal function was still normal.The skin stoma was replaced regularly.Therapeutic effect was poor in a patient with distension and 1 with detaining ureteric branch stand,and patients still had stricture of ureter,which was treated by a surgery.The results demonstrated that the etiology of ureteral obstruction after kidney transplantation was complex,and stenosis of ureterovesical junction was most common.Most of obstruction request surgical management.The graft function and the long-term graft survival were not affected by a correctly treated ureteral obstruction.