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[肾移植术后输尿管狭窄:危险因素及外科治疗]

[Ureteral stricture following renal transplantation: risk factors and surgical management].

作者信息

Liu Lei, Ma Lu-lin, Zhao Lei, Zhang Hong-xian, Hou Xiao-fei

机构信息

Department of Urology, Peking University Third Hospital, Beijing 100191, China.

出版信息

Beijing Da Xue Xue Bao Yi Xue Ban. 2014 Aug 18;46(4):548-51.

Abstract

OBJECTIVE

To evaluate the prevalence and the risk factors of the ureteral stricture following renal transplantation and outcomes of surgical managements.

METHODS

By a retrospective analysis, we assessed 1 293 patients who underwent renal transplantation between January 2001 and December 2013 at our center. The patients with ureteral stricture had undergone surgical management which included neoureterocystostomy, ureteral anastomosis with the native ureter and endoscopic therapy.

RESULTS

Ureteral stricture following renal transplantation was diagnosed in 17 cases (1.3%) including 6 males and 11 females. The mean age of the patients at the time of surgery was 44 (29 to 64) years. The median interval between ureteral stricture obstruction and kidney transplantation was 4 (1 to 120) months. The ureteral stricture was significantly correlated with multiple renal arteries, donor age and delayed graft function. The effective rate of surgical management was 65.75%.

CONCLUSION

The incidence of ureteral stricture as a urologic complication after renal transplantation is low. The advanced techniques that preserve the ureteric blood supply should be applied. The surgical managements have respective advantages and disadvantages. The neoureterocystostomy shows best outcome, while ureteral anastomosis with the native ureter has poor outcome.

摘要

目的

评估肾移植术后输尿管狭窄的发生率、危险因素及外科治疗的效果。

方法

通过回顾性分析,我们评估了2001年1月至2013年12月在本中心接受肾移植的1293例患者。输尿管狭窄患者接受了包括新输尿管膀胱吻合术、输尿管与自体输尿管吻合术及内镜治疗在内的外科治疗。

结果

肾移植术后诊断出输尿管狭窄17例(1.3%),其中男性6例,女性11例。手术时患者的平均年龄为44(29至64)岁。输尿管狭窄梗阻与肾移植之间的中位间隔时间为4(1至120)个月。输尿管狭窄与多支肾动脉、供体年龄及移植肾延迟功能恢复显著相关。外科治疗的有效率为65.75%。

结论

肾移植术后作为泌尿系统并发症的输尿管狭窄发生率较低。应采用保留输尿管血供的先进技术。外科治疗各有优缺点。新输尿管膀胱吻合术效果最佳,而输尿管与自体输尿管吻合术效果较差。

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