腔内技术处理移植肾上尿路结石

Endoscopic techniques on treatment of upper urinary tract calculi in transplanted kidneys

背景:移植肾尿路结石是肾移植一种少见的并发症,因移植肾本身的病理生理的特殊性,临床处理棘手。目的:总结腔内技术处理移植肾上尿路结石的经验并评估其安全性和有效性。方法:回顾性分析采用输尿管镜取石和微创经皮肾取石治疗21例移植肾上尿路结石患者的资料。结果与结论:8例移植肾输尿管结石行输尿管镜取石3例成功,2例取石后出现高热,其中1例需行经皮肾穿刺造瘘引流;5例失败并改行微创经皮肾取石。18例患者行微创经皮肾取石,其中13例患者直接行微创经皮肾取石,5例输尿管镜取石失败后改行微创经皮肾取石。手术均成功且一次性将结石取净,术中术后无并发症发生。说明逆行输尿管镜在处理移植肾上尿路结石的价值有限,微创经皮肾取石处理移植肾上尿路结石安全有效,可作为移植肾上尿路结石的首选治疗方案。

BACKGROUND： Urolithiasis is an uncommon but known complication of renal transplantation and its management is challenging because of the special physiopathology of transplanted kidneys. OBJECTIVE：To summarize our experience of endoscopic techniques on the treatment of upper urinary tract calculi in transplanted kidney and to evaluate its safety and effectiveness. METHODS： The clinical data of 21 patients with upper urinary tract calculi in transplanted kidneys treated by ureteroscopic lithotripsy （URL） or minimally invasive percutaneous nephrolithotomy （mPCNL） was retrospectively analyzed. RESULTS AND CONCLUSION： 8 patients with ureteral stones in transplanted kidney were treated by URL and the procedure was successful only in 3 cases, 2 cases had high fever after stone and 1 of them required a nephrostomy tube to control infection. The other 5 were failed and converted to mPNCL. Total of 18 patients were treated by mPCNL. Among them, 13 patients were treated with mPCNL directly, 5 patients were treated with URL at first and failed and then converted to mPNCL. All patients were rendered stone-free at one mPCNL procedure, with no complications during or after surgery. In treating the calculi in transplanted kidney, the value of URL is limited but mPCNL is safe and effective and it can be regard as the initial therapy.