摘要
目的:探讨经皮顺行通道联合经尿道逆行通道内镜微创手术治疗移植肾输尿管梗阻的方法及效果。方法:回顾北京大学第三医院泌尿外科2007年2月至2013年3月收治的8例术后移植肾输尿管梗阻病例,均采用经皮顺行通道联合经尿道逆行通道双向内镜微创手术完成。其中男3例,女5例,平均年龄44岁(30～64岁),移植肾输尿管梗阻出现时间距肾移植手术1个月至12个月。临床表现:肌酐升高4例,无尿2例,尿瘘2例。梗阻段位于输尿管末段7例,中段1例。3例病例一期急诊行肾造瘘术,二期再行内镜微创手术处理;其余5例病例同期行移植肾造瘘及经皮顺行通道联合经尿道逆行通道双向内镜治疗。结果:8例病例血清肌酐自术前(237±43)μmol/L降至术后(121±29)μmol/L(P<0.05),未出现出血、感染等手术并发症。合并尿瘘的2例患者术后尿瘘愈合。手术成功6例,另2例未成功解决梗阻仅留置移植肾造瘘,其中1例6个月后发生再狭窄,再狭窄发生率17%(1/6)。结论:经皮顺行通道联合经尿道逆行通道双向内镜微创手术作为移植肾输尿管梗阻,特别是肾移植术后早期梗阻病例首选的治疗手段,手术后效果良好。
Objective：To evaluate the method and efficacy of endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach for ureteral obstruction after kidney transplantation.Methods： Eight cases were analyzed retrospectively who received endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach when they had been diagnosed with ureteral obstruction in the transplant kidney from February 2007 to March 2013 in Department of Urology,Peking University Third Hospital.The cases included three males and five females,with the average age being 44 years（30-64 years）.The interval between ureteral obstruction and kidney transplantation ranged from one month to 12 months.Four cases presented with increased serum creatine,two with anuria and two with urinary leakage.The stricture site was located in ureter terminal part in seven cases,and middle part in 1 case.In three cases,percutaneous nephrostomy were carried out immediately while endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach were carried out later.The remaining five cases were treated simultaneously.Results： The average serum creatine decreased from（237±43） μmol/L to（121±29） μmol/L（P＆lt;0.05） after the therapy.No perioperative complications occurred.Two urinary fistula healed.Six cases were treated successfully with two cases that failed followed by percutaneous nephrostomy.The ureteral obstruction recurred in one case after six months with recurrence rate of 17%（1/6）.Conclusion： Endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach is an effective therapeutic approach to treat ureteral obstruction in transplant kidney which shows good clinical results.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2013年第4期588-591,共4页
Journal of Peking University:Health Sciences
关键词
输尿管梗阻
肾移植
内窥镜检查
Ureteral obstruction
Kidney transplantation
Endoscopy
