临床外科杂志 ›› 2022, Vol. 30 ›› Issue (4): 372-375.doi: 10.3969/j.issn.1005-6483.2022.04.020

• 论著 • 上一篇    下一篇

同种异体肾移植术后输尿管狭窄开放手术治疗探讨(附6例报告)

  

  1.  430064 武汉大学人民医院器官移植科
  • 收稿日期:2021-05-25 接受日期:2021-05-25 出版日期:2022-04-20 发布日期:2022-04-20
  • 通讯作者: 周江桥,Email:zhoujq@whu.edu.cn
  • 基金资助:
    国家自然科学基金面上项目(81870067)

Open surgical treatment of ureteral stenosis after renal transplantation(report of 6 cases)

  1. Department of Organ Transplantation,Renmin Hospital of Wuhan University,Wuhan 430064, China
  • Received:2021-05-25 Accepted:2021-05-25 Online:2022-04-20 Published:2022-04-20

摘要: 目的 探讨同种异体肾移植术后移植肾输尿管狭窄的手术治疗方案,分析手术治疗效果与临床实用性。 方法 2018年4月~2020年11月收治的移植肾输尿管狭窄病人6例。6例均行移植肾造口术和移植肾输尿管膀胱再植术,术后对6例病人进行临床随访。 结果 6例病人发生输尿管狭窄为术后1~76个月,平均为术后16.3个月,肾移植术后血肌酐(Cr)100~161 μmol/L ,平均119.8 μmol/L,发生输尿管狭窄后Cr为100~337 μmol/L,平均238.8 μmol/L。6例病人术前均已在规定时限内拔除输尿管支架,在移植肾造口术中均未发生移植肾出血、感染等并发症,移植肾造口术后6例病人肾功能有所恢复,术后Cr 97~283 μmol/L,平均173.5 μmol/L,6例病人均行开放手术,手术时长约1个小时,术中均未发生移植肾输尿管黏膜损伤。术后1例病人发生漏尿,余5例病人未发生术后并发症。术后1个月病人复查Cr为88~197 μmol/L,平均135.3 μmol/L。术后对6例病人均有3~6个月随访,现该6例病人肾功能均已恢复正常水平。 结论 移植肾输尿管狭窄是肾移植术后最严重的并发症之一,开放手术治疗效果明显,术后恢复良好。

关键词: 肾移植, 输尿管狭窄, 输尿管膀胱再植

Abstract: Objective To explore the open surgical treatment of ureteral stricture after renal transplantation,and to analyze the therapeutic effect and clinical practicability of the operation. Methods The clinical data of 6 patients with ureteral stricture after kidney transplantation admitted to the Department of Organ Transplantation,People’s Hospital of Wuhan University from April 2018 to November 2020 were retrospectively analyzed.All the 6 cases underwent nephrostomy status and ureterovesical replantation.Six patients were followed up after operation. Results The ureteral stenosis occurred 1-76 months postoperatively,with a mean of 16.3 months postoperatively.The serum creatinine(Cr) after kidney transplantation was 100-161 μmol/L,with an average of 119.8 μmol/L.After ureteral stenosis,the Cr of patients was 100-337 μmol/L,with an average of 238.8 μmol/L.All the 6 patients had had their ureteral stents removed within the prescribed time limit before surgery No complications such as transplant hemorrhage and infection occurred during renal graft fistula.Renal function recovered in 6 patients after renal graft fistula,and the postoperative CR was 97-283  μmol/L,with an average of 173.5 μmol/L.All the 6 patients underwent open surgery,and no ureteral mucosal injury occurred during the operation.All the 6 patients were followed up for 3 to 6 months after operation.Now the renal function of the 6 patients has returned to normal level. Conclusion Ureteral stricture is one of the most serious complications after renal transplantation.Open operation has the advantages of obvious therapeutic effect and good postoperative recovery.

Key words: renal transplantation, ureteral stricture, ureter-bladder replantation

[1] 黄倩, 陈松, 刘斌等. 肾移植受者继发新型冠状病毒感染免疫抑制方案的调整[J]. 临床外科杂志, 2021, 29(4): 385-387.
[2] 但超 姚启盛 杨勇 龚小新 王黎 王俊霖. 微输尿管镜治疗女性输尿管下段结石合并输尿管狭窄一例[J]. 临床外科杂志, 2021, 29(1): 63-64.
[3] 陈飞 牛玉林 李昆. 马蹄肾劈开移植一例[J]. 临床外科杂志, 2021, 29(1): 81-82.
[4] 杨佐炎 伍骏锋 王良 龙久柱 王宇荣. 输尿管钳钳取治疗结石性输尿管息肉的疗效观察[J]. 临床外科杂志, 2021, 29(1): 93-95.
[5] 常万兴 赵亚昆 王海平 仇宇 祝清国. 肾移植术后人细小病毒B19感染的诊治体会[J]. 临床外科杂志, 2020, 28(9): 882-884.
[6] 罗浩铭, 王金晶, 白钦钦等. 肾移植术后合并气性坏疽一例[J]. 临床外科杂志, 2020, 28(11): 1031-1032.
[7] 伍倩倩, 倪雪峰, 文吉秋. 移植肾继发和新发肾小球疾病诊治新进展[J]. 临床外科杂志, 2020, 28(11): 1090-1094.
[8] 王毅. ABO血型不相容肾移植值得关注的几个问题[J]. 临床外科杂志, 2018, 26(12): 899-902.
[9] 王心强, 郭艳华, 宫念樵等. 中国公民逝世后器官捐献肾移植早期移植肾丢失的原因分析[J]. 临床外科杂志, 2018, 26(12): 903-906.
[10] 谢亚龙, 张伟杰, 陈松等. 肾移植术后坏死性筋膜炎二例报道[J]. 临床外科杂志, 2018, 26(12): 907-909.
[11] 于广才, 昌盛, 陈松等. 移植肾功能恢复延迟伴发横纹肌溶解症一例[J]. 临床外科杂志, 2018, 26(12): 910-912.
[12] 高宝山, 连鑫, 傅耀文等. 以嵌合体为基础的器官移植操控性免疫耐受的研究进展[J]. 临床外科杂志, 2018, 26(12): 976-979.
[13] 赵亚昆 祝清国 仇宇 刘伟 高治忠. 肾移植术后尿路梗阻的诊治体会[J]. 临床外科杂志, 2012, 20(4): 274-274.
[14] 曾宪有 周浩 朱长炎 吴卫真. 肾移植受者移植肾带功能死亡与失功能死亡原因比较[J]. 临床外科杂志, 2011, 19(11): 783-783.
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