腔内泌尿外科技术处理移植肾输尿管梗阻

摘要

背景:移植肾输尿管梗阻是肾移植后最常见的并发症,传统上需采用开放手术修复,但腔内泌尿外科技术的发展和经验的积累已使内镜技术成为临床处理这类并发症的另一选择.目的:回顾性分析腔内泌尿外科技术处理移植肾输尿管梗阻的临床效果.方法:2001-02/2010-10对23例移植肾输尿管梗阻患者采用腔内技术治疗.术中采用气囊扩张或腔内切开梗阻后,留置两条双J管4~6周.术后定期随诊,行B超、肾图和肾功能检查.结果与结论:4例患者采用气囊扩张,19例采用腔内切开.术中均成功将梗阻段扩张或切开,术中和术后无并发症发生.随访6~108个月,14例输尿管引流通畅,肾功能稳定;9例梗阻复发,其中2例采用长期输尿管换管,1例永久肾造瘘,6例患者改开放手术治疗(4例成功,2例失败后采用长期输尿管换管).提示腔内泌尿外科技术处理移植肾输尿管膀胱吻合口梗阻安全、有效,但首次内切开失败后再次腔内治疗的复发率高.%BACKGROUND: Ureteric obstruction is the most common complication after renal transplantation. Traditionally, this complication has been managed with open surgery. Currently, minimally invasive endourological techniques may offer an appropriate alternative to open surgery with the development of endourological techniques and the accumulation of experience.rnOBJECTIVE: To sum up the clinical effect of endourological techniques on ureteric obstrucion in transplanted kidneys.rnMETHODS: Between February 2001 and October 2010, 23 cases of uretertic obstruction in transplanted kidneys were treated by endoscopical technique. After the obstruction was dilated with balloon or completely cut, two double-J stents were placed in the ureter for 4-6 weeks. During follow-up, renal function tests, B ultrasound examination and wash-out renal scintigraphy were performed.rnRESULTS AND CONCLUSION: Balloon dilation was performed in four patients and endoscopic incision was performed in 19 patients. All procedures resulted in successful incision of the obstruction. No complication was recorded during or after the procedure. At the mean follow-up of 6-108 months, 14 patients have ureteral patency and stable renal function, nine patients presented with recurred obstructive uropathy. Among them, two patients required permanent change of ureteral cathers, one patient required permanent nephrostomy, six patients required open surgical correction (four cases successful and two cases failed). Endourological technique for the ureteric obstruction in transplanted kidney is safe and effective. However, if the first endourological procedure fails, the recurrence rate of repeated endoscopic insicion is high.