肾移植术后MRU在集合系统评估中的临床应用

The Clinical Application of MRU in the Assessment of Collection System of After Renal Transplantation

目的文章通过肾移植术后的患者进行MRU检查来评估术后输尿管的情况。方法通过回顾性分析本院22例肾移植术后患者行磁共振多序列多参数成像;均行磁共振多序列扫描(含磁共振平扫、弥散加权成像、磁共振血管成像、磁共振尿路成像);男14例,女8例;2例患者先后进行了两次移植手术。结果14例正常,8例输尿管不同程度扩张;其中7例右侧移植肾输尿管扩张,1例左侧移植肾输尿管扩张;3例右侧输尿管轻度扩张,1例右侧输尿管下端炎性狭窄导致输尿管扩张,1例右侧输尿管下端经手术证实坏死并输尿管瘘形成,1例老年患者移植肾脏为小儿肾脏,在肾移植术后2月未发现输尿管梗阻扩张,但6个月后输尿管上段积水扩张由于周围血肿压迫性所致;1例患者术后19年MRU显示输尿管上段小结石并移植肾积水;最后8例患者均及早行手术干预治疗,解除了以上泌尿系并发症。结论通过MRU无创检查能及时发现肾移植术后患者移植肾泌尿系有无狭窄、梗阻及输尿管瘘情况,能指导临床及时手术干预治疗,从而避免肾移植失败。

Objective To evaluate postoperative ureter status by MRU examination in patients after renal transplantation.Methods A retrospective analysis of 22 patients with renal transplantation in our hospital underwent magnetic resonance multi-sequence multi-parameter imaging;all performed magnetic resonance multi-sequence scanning(including magnetic resonance common scan,diffusion-weighted imaging,magnetic resonance angiography,magnetic resonance urinary tract imaging);14 males and 8 females;2 patients underwent two transplants.Results 14 normal,8 ureter dilatation;7 cases of right renal ureteral dilatation,1 case of left ureteral dilatation;3 cases of mild dilatation of the right ureter;1 case of the lower ureteral dilatation caused by ureteral stenosis;1 case of the right ureteral lower end was confirmed by surgery and ureteral urinary fistula formation;1 case of the right end ureter necrosis with ureteral urinary fistula confirmed by surgery;1 elderly patient with transplanted kidney was a pediatric kidney,which no ureteral obstruction was found in 2 months after renal transplantation,but after 6 months,the upper ureteral dilatation was due to the oppression of peripheral hematoma;1 patient whp MRU showed the small stone in infrarenal fistula and upper ureter with hydronephrosis in 19 years after operation.In the end,8 patients were treated with early surgery intervention and the above urinary tract complications were relieved.Conclusion Non-invasive examination of MRU can timely detect the presence or absence of stenosis,obstruction and ureteral fistula in patients after renal transplantation,and can guide clinical timely surgical intervention to avoid kidney transplantation failure.