肾移植术后长段输尿管狭窄的诊断与开放性手术治疗

目的 总结肾移植术后发生长段输尿管狭窄的诊断方法与手术治疗经验.方法 分析11例肾移植术后发生长段输尿管狭窄患者的临床资料.患者发生长段输尿管狭窄的时间为肾移植术后2～6个月,临床表现为血肌酐升高、体重增加、尿量减少和移植肾区肿胀.所有患者均经B型超声、64层螺旋CT尿路造影(CTU)或磁共振尿路水成像(MRU)确诊,输尿管狭窄长度为3～7 cm.11例患者的治疗方法为:5例行膀胱壁瓣输尿管成形术;2例行供肾肾盂-自体输尿管吻合术;4例行供肾输尿管-自体输尿管吻合术.结果 11例长段输尿管狭窄的患者经开放性手术治疗后,均取得成功,恢复了尿路的通畅.手术时间为2.5～4 h,无明显手术并发症.术后尿量显著增加,血肌酐下降至75～156μmol/L,B型超声示移植肾积水明显减轻或消失.术后随访8～62个月,患者肾功能稳定,无再发狭窄.结论 对肾移植术后出现血肌酐升高等临床特点的患者,应考虑到输尿管狭窄的可能,及时采用B型超声进行常规的检查,采用CTU或MRU明确狭窄的长度及部位;明确诊断后应及时进行开放性手术治疗.肾移植术后的长段输尿管狭窄经早期诊断和及时治疗成功率较高.

Diagnosis and surgical treatment of long distance ureteral stenosis after kidney transplantation

Objective To summarize the experience of diagnosis and surgical treatment of long distance ureteral stenosis after kidney transplantation. Methods Eleven cases of ureteral stenosis following renal transplantation were analyzed. Ureteral stenosis happened between 2-6 months after transplantation. The clinical manifestations were as follows: serum creatinine and weight elevated,urine decreased, graft area swelling. All cases were diagnosed using ultrasound, MRU or CTU. The ureteral obstruction length was 3-7 cm. In 5 patients a Boari flap technique was used, and the native ureter for pyelo-ureterostomy was used in 2 patients. Four patients were subjected to surgical operation using the native ureter for uretero-ureterostomy. Results All of the surgical treatments were successful and no operation-related complications occurred. The operation time was 2. 5 to 4 h.After reconstruction of ureter-bladder anastomosis, the urine was increased, the serum creatinine decreased to 75-156μmol/L, and uronephrosis disappeared or alleviated. The follow-up lasting 8 to 62 months showed no recurrence in all the cases. Conclusion For such cases, ultrasound should be routinely used for the possibility of stenosis. CTU or MRU is important to know the obstruction length and position. For the patients with long distance ureteral stenosis after kidney transplantation,surgical correction is the first choice.