Burgos F J, Bueno G, Gonzalez R, Vazquez J J, Diez-Nicolás V, Marcen R, Fernández A, Pascual J
Department of Urology, Hospital Ramon y Cajal, Universidad de Alcalá, Madrid, Spain.
Transplant Proc. 2009 Jul-Aug;41(6):2427-9. doi: 10.1016/j.transproceed.2009.06.068.
To evaluate the safety and efficacy of nitinol stents and the Detour extra-anatomical ureteral bypass graft in treatment of ureteral stenosis after kidney transplantation.
Eighteen kidney transplant recipients with complex stenosis caused by failure of primary treatment or with high surgical risk or a poorly functioning graft (serum creatinine concentration >2.5 mg/dL) were treated using antegrade percutaneous implantation of nitinol stents (n = 16) or extra-anatomical ureteral bypass grafts (n = 3); 1 patient was treated with both techniques.
Mean (range) follow-up of ureteral stents was 51.2 (3-118) months. Patency rate at last follow-up, resumption of dialysis therapy, or death was 75% (12 of 16 patients). In 4 patients (25%), stent occlusion developed, which was treated using a double-J catheter in 2 patients, stent removal and pyeloureterostomy using the native ureter in 1 patient, and implantation of an extra-anatomical bypass graft in 1 patient. Mean follow-up in patients with extra-anatomical ureteral bypass grafts was 32 (8-64) months. One patient developed a urinary tract infection, and another had encrustation with obstruction.
Use of nitinol ureteral stents and extra-anatomical ureteral bypass grafts is a safe and effective alternative to surgery for treatment of post-kidney transplantation ureteral stenosis in patients with chronic graft dysfunction, those at high surgical risk, and those in whom previous surgical treatment has failed.
评估镍钛合金支架及Detour解剖外输尿管搭桥移植物治疗肾移植术后输尿管狭窄的安全性和有效性。
18例肾移植受者，因初始治疗失败、手术风险高或移植肾功能差（血清肌酐浓度>2.5mg/dL）导致复杂狭窄，采用顺行经皮植入镍钛合金支架（n = 16）或解剖外输尿管搭桥移植物（n = 3）进行治疗；1例患者接受了两种技术治疗。
输尿管支架的平均（范围）随访时间为51.2（3 - 118）个月。末次随访、恢复透析治疗或死亡时的通畅率为75%（16例患者中的12例）。4例患者（25%）发生支架闭塞，其中2例患者采用双J导管治疗，1例患者取出支架并使用自体输尿管进行肾盂输尿管吻合术，1例患者植入解剖外搭桥移植物。解剖外输尿管搭桥移植物患者的平均随访时间为32（8 - 64）个月。1例患者发生尿路感染，另1例患者出现结痂并伴有梗阻。
对于慢性移植肾功能不全、手术风险高以及既往手术治疗失败的肾移植术后输尿管狭窄患者，使用镍钛合金输尿管支架和解剖外输尿管搭桥移植物是一种安全有效的手术替代方法。
