经皮肾穿刺顺行球囊扩张治疗移植肾输尿管梗阻

目的探讨经皮肾穿刺顺行球囊扩张治疗移植肾输尿管梗阻的安全性和疗效。方法回顾性分析2007年至2011年华中科技大学附属协和医院6例接受经皮肾穿刺顺行球囊扩张治疗移植肾输尿管梗阻的患者资料。所有患者先行B超引导移植肾穿刺造瘘，顺行造影确定梗阻的具体位置，顺行球囊扩张输尿管狭窄段，术后留置双J管和肾造瘘管，无效则改开放手术。结果6例患者中1例输尿管狭窄段〉1cm，球囊扩张失败，1例合并尿瘘，尿囊肿，扩张治疗无效，此2例均经开放手术治愈；其余4例一次扩张治愈，随访16～38个月，肾功能正常，无梗阻复发。结论经皮肾穿刺顺行球囊扩张安全、损伤小，可作为治疗移植肾输尿管梗阻的首选方法，对于合并有其他外科并发症或扩张治疗失败的患者，需开放手术治疗。

Percutaneous antegrade balloon dilatation for the treatment of ureteral strictures after renal transplantation

Objective To evaluate the safety and efficacy of percutaneous balloon dilatation for the treatment of ureteral stricture after renal transplantation. Methods Data of 6 cases who received percutaneous antegrade balloon dilation when di- agnosed as ureteral obstruction after renal transplantation during 2007 to 2011 in our hospital were retrospectively analyzed. All patients underwent percutaneous nephrostomy with B ultrasound guidance. The position of ureteral strictures was diagnosed with anterograde venography. Antegrade balloon dilation and double-J stent in ureter were performed subsequently. The cases changed to open surgery if the initial treatment failed. Results Two cases failed, the stricture length of 1 case was longer than lcm, and the other case was complicated with urinary fistula and urinoma. The two patients changed to open surgery and were cured. Four patients were successfully treated with one dilatation, the transplant kidney function was stable and no ureteral obstruction was seen during 16-38 months of follow-up. Conclusion Antegrade balloon dilation is a safe, minimally invasive and useful method to treat ureteral strictures after renal transplantation. Open surgery is necessary for patients with dilation failure or other complications.