肾移植术后移植肾输尿管狭窄的危险因素分析及手术治疗

Ureteral stricture following renal transplantation:risk factors and surgical management

目的：评估肾移植术后移植肾输尿管狭窄的发生率及其危险因素,以及各种手术治疗的效果.方法：回顾分析北京大学第三医院泌尿外科2001年1月至2013年12月1 293例肾移植患者相关数据,对发生移植肾输尿管狭窄的17例患者进行危险因素分析,17例患者手术治疗方式包括移植肾输尿管狭窄段切除、输尿管膀胱再吻合术,移植肾肾盂与原输尿管吻合术,内镜微创手术,对此17例患者进行术后随访.结果：肾移植术后出现移植肾输尿管狭窄17例,发生率为1.3％,男6例,女11例,患者手术时平均年龄44岁（29～64岁）,发生移植肾输尿管狭窄距移植手术中位时间为4个月（1～120个月）,移植肾输尿管狭窄的危险因素包括供肾动脉的数量、移植物功能延迟恢复、供者的年龄.手术治疗的总有效率为65.75％.结论：移植肾输尿管狭窄的总体发生率较低,获取和修肾时要采取保留输尿管血供的方法.手术治疗包括开放手术和内镜微创手术等多种术式,不同方法有各自的优缺点,移植肾输尿管膀胱再吻合术的治愈率最高,移植肾肾盂原输尿管再吻合的手术结果不理想.

Objective：To evaluate the prevalence and the risk factors of the ureteral stricture following renal transplantation and outcomes of surgical managements. Methods： By a retrospective analysis, we assessed 1 293 patients who underwent renal transplantation between January 2001 and December 2013 at our center. The patients with ureteral stricture had undergone surgical management which included neoureterocystostomy, ureteral anastomosis with the native ureter and endoscopic therapy. Results： Ure- teral stricture following renal transplantation was diagnosed in 17 cases （ 1.3% ） including 6 males and 11 females. The mean age of the patients at the time of surgery was 44 （29 to 64） years. The median in- terval between ureteral stricture obstruction and kidney transplantation was 4 （ 1 to 120） months. The ureteral stricture was significantly correlated with multiple renal arteries, donor age and delayed graft function. The effective rate of surgical management was 65.75%. Conchlsion： The incidence of ureteral stricture as a urologic complication after renal transplantation is low. The advanced techniques that pre- serve the ureteric blood supply should be applied. The surgical managements have respective advantages and disadvantages. The neoureterocystostomy shows best outcome, while ureteral anastomosis with the native ureter has poor outcome.