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目的 探讨肾移植术后尿路梗阻的原因,总结诊断和治疗经验.方法 回顾性分析我院1996年2月至2010年12月收治的14例肾移植术后尿路梗阻患者的临床资料.12例患者因血清肌酐进行性升高发现尿路梗阻,2例因尿瘘、尿外渗发现.均行开放手术治疗,术中发现输尿管末段狭窄,行输尿管膀胱吻合术.结果 所有患者移植肾功能于术后1~3周明显改善,移植肾积水于术后3~6周渐恢复.随访期间未见有尿路梗阻致移植肾积水.结论 尿路梗阻是肾移植术后严重并发症,加强围手术期管理,术中精细操作可有效预防其发生.超声和磁共振尿路成像对诊断有较大帮助.积极治疗可有效延长移植肾的存活,具有重要临床意义. 相似文献
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目的:探讨肾移植术中供肾输尿管异常的手术处理方法。方法:回顾性分析18例供。肾输尿管异常的肾移植术中处理,包括损伤致输尿管过短8例,完全型双输尿管4例,不完全型双输尿管2例,输尿管结石2例,巨输尿管2例。根据具体情况采用输尿管膀胱吻合术、供受者输尿管端端吻合术和膀胱腰大肌悬吊术等方法再植输尿管。结果:术后恢复顺利,未发生移植肾功能延迟恢复和尿漏。随访3~8年,发生输尿管梗阻1例,行经皮。肾造口输尿管镜切开后治愈。发生尿路感染5例(其中2例为反复感染)。未见膀胱输尿管返流。结扎输尿管的原肾未出现胀痛和不适,B超检查未见肾积水。带输尿管结石移植肾未见结石复发。巨输尿管供肾移植后输尿管管径稳定,无明显增大。结论:供肾输尿管损伤和异常时采用不同的技术修复和再植输尿管,可减少并发症的发生。 相似文献
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自体膀胱瓣管-移植肾肾盂吻合术处理输尿管坏死 总被引:3,自引:0,他引:3
目的探讨自体膀胱瓣管移植肾肾盂吻合术处理肾移植术后输尿管长段坏死的效果。方法13例患者肾移植术后发生输尿管长段坏死,将其膀胱皮瓣围绕输尿管内支架管(双J管)缝合成管状,以代替坏死的输尿管,上部修剪成斜形后,与移植肾肾盂吻合。留置双J管做支架管,切口留置胶管引流。结果13例患者均成功进行移植肾肾盂膀胱瓣管吻合术,其中1例术后7d发生严重肾周感染而切除移植肾,其余12例肾功能恢复良好,术后随访1年,2例出现返流,人、肾1年存活率分别为100%(13/13)、92.3%(12/13)。结论自体膀胱瓣管移植肾肾盂吻合术是治疗肾移植术后输尿管长段坏死的有效手段。 相似文献
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目的:总结采用自体肾移植术治疗长段输尿管缺损的临床疗效和体会。方法对10例输尿管中上段结石患者,在经输尿管硬镜钬激光碎石时出现长段输尿管黏膜袖套状剥脱或全层撕脱,内镜下放置双 J 管失败,无法行输尿管端端吻合或再植,于损伤发生2 h 至9 d 后行自体肾移植术。结果1例术前肾功能严重减退患者术后7 d 出现移植肾栓塞,其余9例随访5~75个月,移植肾血流灌注良好,肾功能维持正常水平;1例术后4个月出现膀胱吻合口狭窄致自体移植肾中度积水,给予微创经皮肾穿刺造瘘引流;尿路感染1例,经抗感染治疗后好转,未见复发。结论针对医源性长段输尿管撕脱伤患者,及时施行自体肾移植可以有效恢复尿路完整性并保持肾功能,且并发症发生率低。 相似文献
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目的 评价改良输尿管剥脱术在处理移植肾同侧发生的原肾肾盂肿瘤中的临床价值.方法肾移植术后发生移植肾同侧原肾肾盂肿瘤患者7例.男2例,女5例.年龄36~57岁,平均54岁.行后腹腔镜下原肾切除,用5 F输尿管导管作为输尿管剥脱器,将输尿管肌层固定于输尿管导管末端,于尿道外口持续缓慢外牵输尿管导管至尿道口外,再次置入膀胱电切镜,于管口处将输尿管与膀胱连接的黏膜切断,切除输尿管及其膀胱壁内段,移除输尿管.观察患者手术前后移植肾功能指标、手术时间、出血量及手术相关并发症.结果 7例均成功完成输尿管剥脱术.手术时间105~160 min,平均126 min;出血量80~160 ml,平均124 ml.术后行膀胱灌注化疗.7例均未出现术中输尿管断裂、输尿管牵出困难等并发症.术前及术后6个月肌酐平均值分别为136.5、138.6μmol/L,尿素氮7.42、7.80 mmol/L,手术前后比较差异无统计学意义.1例合并膀胱肿瘤者术后3个月肿瘤复发,再次手术治疗.余6例随访6个月未见肿瘤复发.结论 肾移植术后并发同侧原肾肾盂肿瘤的患者采用输尿管剥脱处理输尿管创伤小、操作简便. 相似文献
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移植肾活组织检查(活检)依然是诊断移植术后肾功能异常的“金标准”。肾移植术后穿刺活检依据患者肾功能分为指示性活检及程序性活检。指示性活检主要用于诊断肾移植并发症、判断病情严重程度并指导后续治疗;程序性活检主要用于定期监测肾移植受者移植肾功能,以排除亚临床排斥反应等并发症。因患者意愿等原因,程序性活检在我国未能广泛应用,指示性活检是现今主要的活检方式。目前指示性活检穿刺指征、程序性活检穿刺时机及必要性仍存在争议。本文对肾移植术后穿刺活检分类、基于活检的组织生物标志物研究进展进行综述,旨在为协助临床进行肾移植术后并发症的明确诊断和针对性治疗,进一步提高移植肾和受者的良好存活提供参考依据。 相似文献
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腹腔镜手术治疗肾移植术后上尿路肿瘤的技术改进(附11例报告) 总被引:1,自引:0,他引:1
目的 探讨腹腔镜下手术治疗肾移植术后上尿路肿瘤的技术方法及临床应用价值.方法 11例肾移植术后上尿路肿瘤患者.男3例,女8例.平均年龄45岁(39~51岁).肿瘤位于左侧4例,右侧7例;与移植肾同侧8例.采用后腹腔镜根治性肾切除联合经尿道膀胱袖套状切除术,手助处理输尿管下段,标本自腰部小切口取出.观察手术时间、术中出血量、住院天数、并发症及手术效果.结果 11例平均手术时间150 min(90~190 min),术中平均出血量100ml(50~200ml),术后平均住院时间10 d(9~12 d),术中术后均未发生严重并发症.随访2~16个月,肿瘤无复发及远处转移.术后移植肾功能良好.结论 腹腔镜辅以手助处理输尿管末段治疗肾移植术后上尿路肿瘤效果良好,具有临床推广价值. 相似文献
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目的探讨肾移植术后上尿路梗阻的诊断及处理。方法回顾总结2000—2006年我院1090例肾移植患者中的14例移植后上尿路梗阻患者,其中输尿管膀胱吻合口狭窄9例,6例行膀胱输尿管二次吻合手术,1例移植肾周感染输尿管末段坏死采用移植肾近端新鲜存活输尿管与自体输尿管吻合,1例采用膀胱肌瓣代移植输尿管,1例采用输尿管镜下气囊扩张后放置双J管。出血相关性梗阻、输尿管扭曲和输尿管结石所致梗阻5例,均行开放手术。结果14例肾移植术后上尿路梗阻患者中2例切除移植肾,其余各例患者经开放手术及腔镜处理均成功挽救移植肾功能。再次手术后随访0.5—1年,血肌酐68-155μmol/L,B超未见移植肾扩张积水加重。结论新上尿路梗阻是肾移植术后常见亦是较为棘手的外科并发症,多数和外科手术操作有关,可以通过提高手术技巧避免。一旦发生上尿路梗阻,应根据梗阻原因采取相应的治疗方法及时处理。 相似文献
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Objectives. In most endourology programs an interventional radiologist is employed to acquire renal access for percutaneous renal surgery. Over the last 13 years the senior endourologist at Oregon Health Sciences University has acquired access without employing a radiologist. We report our experience with urologist-acquired renal access for percutaneous renal surgery in 522 cases.Methods. We reviewed the records of all patients at our hospital who underwent percutaneous renal surgery between August 1983 and December 1996 with renal access being obtained in the operating room by a urologist.Results. Four hundred fifty-six patients underwent 522 procedures. Indications for percutaneous renal surgery were renal and proximal ureteral calculi (n = 516), retained ureteral stent (n = 3), and intrarenal collecting system tumor (n = 3). We were successful in gaining access to 513 of 522 kidneys (98.3%). Access was obtained via a subcostal approach in 344 procedures, over the 12th rib in 152 procedures, over the 11th rib in 15 procedures, and transabdominally in 2 procedures. Sixty-five patients (12.7%) required a second or multiple sites to facilitate complete removal of calculi. Our overall complication rate was 15.3%. Blood transfusion was required in 5.4% of the cases, ileus developed in 1.9%, pneumothorax in 1.1%, intraoperative hydrothorax in 1.1%, postoperative pleural effusion requiring aspiration in 0.9%, and septic shock in 0.9%. Our overall success rate for stone removal was 94.5%.Conclusions. In our experience, the urologist is able to safely and effectively obtain percutaneous access to the collecting system for percutaneous renal surgery as a one-stage procedure without the aid of interventional radiologists. 相似文献
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Yasunori Itoh Takehiko Okamura Shoichi Sasaki Yutaro Hayashi Kenjiro Kohri 《International journal of urology》1998,5(6):604-605
We report a renal adenoma associated with renal cyst formation in a 49-year-old male. A small renal mass inside a right renal cyst was discovered incidentally by ultrasonography. A right nephrectomy was performed. A pathologic examination revealed a well-differentiated, benign papillary tumor which was composed of slightly eosinophilic cells. We therefore diagnosed this patient as having a renal adenoma with hemorrhage. 相似文献
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In patients with renal impairment, the incremental benefits from administration of contrast media for imaging studies need
to be carefully assessed relative to the potential increased risks of worsening renal dysfunction and systemic adverse effects.
This review provides an overview of risk and benefits of iodinated and gadolinium-based contrast agents; examines their relationships
to contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF), respectively; and discusses various clinical
strategies to minimize the risk of CIN and NSF. Specifically, renal imaging strategies aimed to minimize the adverse effects
of contrast media as well as alternatives to iodinated and gadolinium-based contrast-enhanced renal imaging are proposed with
emphasis on non–contrast-enhanced magnetic resonance imaging. 相似文献
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肾脓肿在其机化的晚期,就其影象学表现,不管是尿路造影、超声显象,或是在CT 扫描上,与肾实质肿瘤坏死的鉴别比较困难。 相似文献
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