移植肾输尿管全长坏死的诊断与治疗

Diagnosis and treatment of complete necrosis of the ureter after cadaveric renal transplantation

目的 提高对肾移植术后移植肾输尿管全长坏死的认识 ,以期及早诊断和有效治疗。方法 对 1991年 1月～ 2 0 0 1年 4月收治的 5例移植肾输尿管全长坏死患者的诊断和治疗情况进行回顾性总结。 5例患者首发症状皆为漏尿 ,B超和核磁共振 (MRI)水成像是重要的辅助诊断方法。 1例患者 1次手术探查行移植肾肾盂自体输尿管吻合术 ;4例患者第 2次探查手术行移植肾肾盂与自体输尿管或肾盂吻合术。 结果 5例患者末次手术后尿量为 15 0 0～ 30 0 0ml/d ,2周内血清肌酐 <15 0 μmol/L ,尿素氮 <8 5mmol/L。随访 6～ 12个月 ,全部患者皆无肾积水。 结论 肾移植术后因漏尿行手术探查 ,发现末端输尿管坏死时 ,应该考虑到可能有输尿管全长坏死。

Objective To deepen the understanding of patients with complete necrosis of the ureter after renal transplantation for early diagnosis and treatment. Methods Of 5 patients with complete necrosis of the ureter after nenal transplantatioin between January 1991 and April 2001 in our hospital, 4 were male and 1 was female (mean age, 35 years). Seven to 12 days after renal transplantation, native pyeloureterestomy was performed for 1 patient, and the remaing 4 patients received the cutting of the diatal necrosis ureter and vesicoureterostomy because of urine leakage. Six to seven weeks later when the ureter stents were pull out, native pyeloureterestomy or pyeloureteroplasty was performed for the 4 patients because of uropenia and hydronephrosis. Results Five patients showed normal function of the kidney postopcration (follow up: 6-12 months) without hydronephrosis. Conclusious When distal necrosis of the ureter is observed after renal transplantation, complete necrosis of the ureter may occur. Native pyeloureterostomy or pyeloureteroplasty is an effective treatment.