移植肾尿路结石46例诊治体会

目的探讨肾移植术后尿路结石的诊断和治疗,提高长期存活率。方法回顾性分析1980年1月至2011年6月46例移植肾结石患者的临床资料。结果 35例为肉眼血尿,10例为体检时B超发现,1例为急性无尿发病,均无肾绞痛。移植肾结石24例,移植输尿管结石22例,结石大小0.7～2.0 cm,结石发病时间为术后3.5（0.4～15）年。42例行体外冲击波碎石（ES-WL）,其中3例无效行输尿管镜下钬激光碎石术和1例行经皮肾镜取石术（PCNL）,4例尿酸结石给予枸橼酸氢钾钠（友来特）药物治疗。随访3个月：42例ESWL中,结石排净36例（85.72%）,结石残留2例（4.76%）,4例（9.52%）无效改用腔镜治疗后结石排出;4例尿酸结石口服枸橼酸氢钾钠结石大部分排出。结论移植肾结石缺乏典型肾绞痛表现,体外冲击波碎石术是治疗移植肾结石安全、有效的主要方法。

The diagnosis and treatment of urolithiasis in allograftkidneys(a report of 46 cases)

Objective To investigate the diagnosis and treatment of urolithiasis in allograft kidneys and to enhance the long-term survival rate.Methods Data of 46 cases of urolithiasis in allograft kidneys treated during Jan.1980 to June 2011 were retrospectively analyzed.Results 35 cases had gross hematuria,10 were detected during ultrasound examination,and 1 case was acute anuria.None of the cases developed renal colic.Of the 46 cases,24 had renal stones and 22 ureteral stones.The stone size ranged from 0.7 to 2.2 cm.The stones developed 4 months to 15 years after surgery.42 cases received extracorporeal shock-wave lithotripsy(ESWL),3 of which received ureteroscopy and 1 percutaneous nephrolithotripsy(PCNL) after ESWL failed.The other 4 cases were uric acid stones,which were discharged after the patients took potassium and sodium hydrogen citrate.During the follow-up of 3 months,the overall stone-free rate after ESWL was 88.1%(37/42).2 cases(4.7%) had residual fragments.4 cases(7.1%) failed,were treated with endoscopy and stones were removed.The 4 patients taking potassium and sodium hydrogen citrate had most stones discharged.Conclusions Urolithiasis in allograft kidneys develops no typical symptom of renal colic.ESWL is safe and effective to treat lithiasis in transplanted kidneys.