移植肾积水的微创治疗(附24例报告)

Minimally invasive treatment for hydronephrosis after renal transplantation: a report of 24 cases

目的探讨肾移植后肾积水的微创治疗方法及疗效。方法 24例肾移植术后肾积水患者,根据病情采取不同的微创治疗。16例患者在输尿管软镜下行双J管植入,6例患者在B超和X线透视导向下采用同轴穿刺法行肾造瘘＋介入治疗,2例患者采取超声引导下经皮肾同轴穿刺引流术,待一般状况恢复后行输尿管膀胱吻合术。术后观察尿液颜色、尿量,并复查肾功能。结果 24例患者行B超及泌尿系水成像（MRU）检查均显示不同程度肾积水和输尿管梗阻,其中输尿管完全梗阻2例,不完全梗阻22例。行经皮穿刺肾输尿管狭窄段球囊扩张联合内外引流术6例,输尿管软镜下支架管置入术16例,经皮肾造瘘外引流术2例。患者血清尿素氮和肌酐水平术前分别为35.3mmol/L和397.7μmol/L,术后1周分别下降至9.7mmol/L和124.6μmol/L。术后B超检查示移植肾积水消失。随访4~12个月,2例外引流患者一般状况好转后行开放手术,其余患者均无肾积水复发。结论微创治疗尤其是输尿管软镜治疗具有操作简便、创伤小和并发症少的特点,是移植肾积水安全、有效的治疗方法。

Objective To study the procedure and therapeutic effects of minimally invasive treatment for the hydronephrosis after renal transplantation.Methods Twenty-four patients with hydronephrosis after kidney transplantation were treated with different operations according to patients＇ condition.Sixteen patients were inserted with Double-J stents were inserted through the Flexible ureteroscope in 16 patients;in six patients it was drained with nephrostomy through coaxial puncture under the guidance of B-type ultrasonography and X-ray fluoroscopy;in two patients if was drained by percutaneous coaxial puncture under ultrasound guidance,followed by ureterocystoneostomy when the general condition recovered.The color and volume of urine of all patients were monitored,and the urine routine tests and renal function were rechecked.Results The ultrasonic inspection and MRI showed that all the 24 patients suffered from different degree of hydronephrosis and ureteral obstruction,including 2 cases of complete ureteral obstruction and 22 cases of incomplete ureteral obstruction.Sixteen patients received insertion of double-J stent under Flexible ureteroscope,6 patients underwent nephrostomy by coaxial puncture under the guidance of B-type ultrasonography and X-ray fluoroscopy,and 2 patients underwent percutaneous nerphrostomy with coaxial puncture technique under ultrasound guidance.All the operations were very successful.The average levels of serum urea nitrogen and creatinine lowered from 35.3mmol/L and 397.7μmol/L,respectivaty,before operation to 9.7mmol/L and 124.6μmol/L,respectively,one week after the operation.Hydronephrosis disappeared after the operation,and there was no recurrence in all patients during the period of 4 to 12 months follow up.Conclusions Characterized with simple manipulation,less invasion and complications,minimally invasive treatment,especially the Flexible ureteroscope,is a reliable and effective method for hydronephrosis after kidney transplantation.