肝移植术后尿路结石的外科治疗经验

The surgical experience of urinary calculi after liver transplantation:A report of two cases

目的探讨肝移植术后合并尿路结石的危险因素、临床特征和诊治经验。方法回顾性分析2003年10月至2008年12月间在本院进行肝移植的742例受者(肝移植726例,肝肾联合移植16例)的临床资料。结果在单纯肝移植中尿路结石发生率为0.4%(3/726),在肝肾联合移植中发生率为6.3%(1/16)。2例男性受者(肝移植1例,肝肾联合移植1例)接受了经皮肾镜碎石、取石术,术后肾功能恢复正常。例1尿路结石发现于第一次肝移植术后36个月,肝肾联合移植术后21个月;例2尿路结石发现于肝移植术后19个月。高尿酸血症、免疫抑制剂(他克莫司、泼尼松)、尿路感染可能是肝移植术后尿路结石形成的诱因。结论肝移植术后患者合并尿路结石应及时手术治疗,其预后良好。

Objective To explore risk factors,the clinical characteristics,diagnosis and treatments of urinary calculi after liver transplantation（LT）.Method The clinical data of 742 patients undergoing LT（LT 726 patients,combined liver-kidney transplantation 16 patients）from October 2003 to December 2008 were analyzed in our institution.Result The morbidity of urinary calculi after LT and CLKT were 0.4%（3/726） and 6.3%（1/16）.Two male recipients（CLKT case 1 and LT case 2） accepted the operation of macadam and calculus removed by percutaneous nephrolithotomy.The renal function recovered after operation.Urinary calculi was detected in 36 months after primary LT and in 21 months after CLKT in case 1.Urinary calculi was detected in 19 months after LT in case 2.Hyperuricemia,immunosuppressive agents（tacrolimus,prednisone）,urinary tract infection may be the inducement of urinary calculi after LT.Conclusion Patients with urinary calculi after liver transplantation must accept surgical treatment in time.The prognosis is good.