肾移植术后尿路梗阻的处理(附16例报告)。

Hai-bo Nie, Hui-xu He, Xun Li, Zhi-xiong Deng, Yun-song Zhu, Wei-lie Hu, Jun Lu, Xiao-fu Qiu, Xiao-ming Zhang
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引用次数: 0

摘要

目的:探讨累及移植肾的尿路梗阻的诊断和治疗方法。方法:回顾性分析16例累及移植肾的尿路梗阻,其中输尿管结石5例,膀胱输尿管吻合口狭窄6例,移植后肾盂输尿管连接处狭窄2例,移植排斥反应所致输尿管坏死1例,移植肾周围感染及输尿管终末坏死2例。结果:1例患者因大出血行开腹手术矫正尿路梗阻,其余患者均行内镜或开腹手术,移植肾功能均得以保留。第二次手术后随访0.5 ~ 3年,患者血清肌酐维持在90 ~ 150微mol/L范围内,b超未见肾脏进一步增大或肾潴留加重。结论:肾移植术后尿路梗阻是一种较为困难的手术并发症,根据梗阻的原因,可采取内镜或开腹手术治疗。
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[Management of urinary obstruction following renal transplantation: report of 16 cases].

Objective: To explore the diagnosis and treatment of urinary obstruction involving the transplanted kidney.

Methods: A retrospective analysis was performed in 16 cases of urinary obstruction involving the transplanted kidney, including 5 cases of ureteral calculi, 6 vesicoureteral anastomotic stricture, 2 pyeloureteral junction stricture after transplantation, 1 ureter necrosis due to graft rejection, and 2 infection surrounding the renal graft and ureter end necrosis.

Results: Only one patient had the renal graft removed due to massive hemorrhage in an open surgery for correction of urinary obstruction, and the renal function of the graft was preserved in all the other cases after endoscopic or open surgeries. In the follow-up for 0.5 to 3 years after the second surgery, serum creatinine of the patients were maintained within the range of 90-150 micromol/L, without further renal enlargement or exacerbation of renal retention shown by B-mode ultrasonography.

Conclusion: Urinary obstruction after renal transplantation is a difficult surgical complication, which can be managed by endoscopic or open surgeries depending on the causes of the obstruction.

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