ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2021, Vol. 30 ›› Issue (5): 440-444.DOI: 10.3969/j.jssn.1006-298X2021.5.008

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移植肾输尿管狭窄腔内治疗后开放手术的疗效

  

  • 出版日期:2021-10-28 发布日期:2021-10-28

Clinical experience of open surgery for ureteral stricture after endoureteral treatment in renal transplantation

  • Online:2021-10-28 Published:2021-10-28

摘要: 目的:总结移植肾输尿管狭窄腔内手术失败后接受开放手术治疗患者的临床治疗经验,探讨术中及术后注意事项。
方法:收集2015年12月至2019年9月因肾移植术后移植肾输尿管狭窄于西京医院接受腔内治疗后失败的11例患者的临床资料,分析术中问题,并通过所有开放手术治疗移植肾输尿管梗阻的经验,总结术中、术后注意事项。
结果:11例患者手术均顺利完成,手术时间25~8h,其中6例行移植肾输尿管再植术,2例行移植肾输尿管膀胱肌瓣成形术,2例行移植肾肾盂膀胱吻合术;1例行移植肾输尿管松解术。术中均重新放置双J管,根据术中情况留置肾造瘘管、膀胱造瘘管、尿管及移植肾周引流管。术后9例患者恢复良好,肾积水较前明显好转,术后3月时血清肌酐较术前显著下降(104±294 μmol/L vs 285±357 μmol/L,P<005)。无一例患者发生严重出血、损伤髂血管及移植肾血管、血肿等并发症。
结论:腔内手术失败的移植肾输尿管狭窄,行开放手术仍可取得较好的临床疗效。


Abstract: Objective:To collect the patients who received open surgery after failure of endoureteral surgery, summarize the clinical treatment experience, and discuss the intraoperative difficulties and postoperative precautions.
Methodology:From Dec 2015 to Sep 2019, the clinical data of 11 patients with ureteral stricture after renal transplantation who failed endoureteral treatment in Xijing hospital were collected. According to the condition of operation, different types of open surgery were used. The difficulties and solutions were summarized.
Results:All the 11 patients were successfully operated, and the operation time was 25~8h. Among them, 6 patients received replantation of transplanted kidney and ureteral, 2 patients received graftureteralbladder muscle flap plasty, and 2 patients received pelvisbladder anastomosis. Ureterolysis was performed in 1 case. Double J tubes were placed again during the operation. Nephrostomy tube, vesicostomy tube, urinary catheter and drainage tube around the transplanted kidney were placed according to the situation during the operation. 9 patients recovered well after operation, and hydronephrosis was improved significantly. The serum creatinine was 285±357 μmol/L before operation and 104±294 μmol/L three months after operation(P<005). Hydronephrosis improved but renal function did not recovered in another case.
Conclusion:Open surgery is effective in the treatment of ureteral stricture after failed endoureteral operation.