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目的探讨肾移植术后新尿路梗阻的诊断及处理对策。方法回顾总结1983-2004年我院485例肾移植病人中的16例移植后新尿路梗阻患者,其中移植肾输尿管结石5例,采用输尿管镜下气压弹道碎石术;输尿管膀胱吻合口狭窄6例,3例开放手术,3例经皮移植肾穿刺高压气囊扩张后放置双J管;移植肾肾盂输尿管连接部狭窄梗阻2例,采用输尿管镜下气囊扩张,放置记忆合金支架;输尿管排斥全程坏死1例,采用带血管蒂回肠段代移植坏死输尿管;移植肾周感染、输尿管末段坏死2例,采用移植肾近端新鲜存活输尿管与自体输尿管端侧吻合。结果16例肾移植术后新尿路梗阻患者中1例开放手术大出血切除移植肾。其余各例患者经腔镜处理及开放手术均成功挽救移植肾功能。再次手术后随访0.5￣3年,血肌酐90￣150μmol/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,处理宜遵循先腔内后开放的思路针对引起梗阻的具体原因部位采用相应的术式。
Objective To investigate the diagnosis and treatment of new urinary tract obstruction after renal transplantation. Methods From 1983 to 2004, 485 cases of renal transplant patients in our hospital 16 cases of new urinary tract obstruction after transplantation, of which 5 cases of renal graft ureter, ureteroscopic pneumatic lithotripsy; ureteral bladder anastomotic stenosis 6 Three cases of open surgery, three cases of percutaneous transplanted renal patency balloon dilatation placed double J tube; renal pelvis and ureteropelvic stenosis obstruction in 2 cases, the use of ureteroscopic balloon dilation, memory alloy stent placement; ureteral rejection full of necrosis 1 case, with vascularized ileum on behalf of the necrosis of the ureter transplantation; perineal infection, 2 cases of distal ureteral necrosis, the use of proximal renal proximal ureter ureter and autologous ureteral end-to-end anastomosis. Results In 16 patients with neo-urinary tract obstruction after renal transplantation, 1 patient underwent open surgery and hemorrhage to remove allograft kidneys. The remaining cases of patients by endoscopic treatment and open surgery were successful in saving renal graft function. Followed up again after surgery 0. 5 ~ 3 years, serum creatinine 90 ~ 150μmol / L, B superfluous graft fluid did not see the expansion of aggravate. Conclusions The new upper urinary tract obstruction is a common and difficult surgical complication after renal transplantation. The treatment should follow the idea of opening within the first cavity and then adopt the appropriate surgical procedure for the specific cause of obstruction.