覆膜金属支架在移植肾输尿管狭窄中的应用

Membrane-covered Metallic Stent in the Treatment of Secondary Ureteral Stenosis After Kidney Transplantation

目的评估新型覆膜金属支架用于移植肾输尿管狭窄的安全性和有效性。方法回顾性分析2018年12月~2019年10月使用覆膜金属支架治疗的7例移植肾输尿管狭窄的临床资料。结果7例输尿管狭窄均位于移植肾输尿管膀胱连接部,狭窄段长5~15 mm,平均10 mm,均成功植入覆膜金属支架。6例术前、术后肾功能均正常;1例术前血肌酐455μmol/L,术后3天降至178μmol/L。7例术后3个月复查利尿肾图及尿路造影,提示上尿路引流通畅。随访3~11(6.6±2.6)月。1例术后3个月输尿管狭窄消失,覆膜金属支架排至膀胱,使用输尿管镜经尿道取出。7例均未发生尿路感染、结石形成、下腹痛等。结论覆膜金属支架治疗移植肾输尿管狭窄安全有效。

Objective To evaluate the safety and efficacy of novel membrane-covered metallic stent in the treatment of patients with secondary ureteral stenosis after kidney transplantation.Methods We retrospectively analyzed the clinical data of seven patients with secondary ureteral stenosis after kidney transplantation treated by novel membrane-covered metallic stent from December 2018 to October 2019.Results The ureteral stenosis was located in the ureteral bladder junction of the transplanted kidney in all the 7 cases.The average length of the stenosis was 10 mm(range,5-15 mm).The stent placement was completed successfully in all the cases.Six cases maintained normal renal function before and after surgery;1 case showed a decreased serum creatinine from 455 to 178μmol/L 3 days after surgery.The diuretic nephrogram and urography were reviewed 3 months after surgery,suggesting that the upper urinary tract drainage was unobstructed.During the overall follow-up period for 3-11 months(mean,6.6±2.6 months),1 case showed the ureteral stenosis was resolved spontaneously,and the metallic stent was expulsed into the bladder 3 months after surgery,which was removed through the urethra by using ureteroscope.No complications such as urinary tract infection,urinary tract stone or pain symptoms occurred.Conclusion Use of novel membrane-covered metallic stent is safe and effective in the treatment of patients with secondary ureteral stenosis after kidney transplantation.