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同种异体肾结石在活体供肾移植受者微创治疗中的结果:单中心 3758 例肾移植经验。

Results of minimally invasive surgical treatment of allograft lithiasis in live-donor renal transplant recipients: a single-center experience of 3758 renal transplantations.

机构信息

Department of Urology, Altinbas University, Istanbul, Turkey.

Department of Urology, Medical Park Hospital, Muratpaşa, Antalya, Turkey.

出版信息

Urolithiasis. 2019 Jun;47(3):273-278. doi: 10.1007/s00240-018-1051-0. Epub 2018 Feb 26.

Abstract

Allograft lithiasis is a rare urologic complication of renal transplantation (RT). Our aim is to present our experience with minimally invasive surgical treatment of allograft lithiasis in our series of live-donor renal transplant recipients. In a retrospective analysis of 3758 consecutive live-donor RTs performed in our center between November 2009 and January 2017, the results of minimally invasive surgery for the treatment of renal graft lithiasis diagnosed at follow-up were evaluated. Twenty-two (0.58%) patients underwent minimally invasive surgery for renal graft lithiasis. The mean age was 41.6 years, and duration between RT and surgical intervention was 27.3 months (range 3-67). The mean stone size was 11.6 mm (range 4-29). Stones were located in the urethra in 1, bladder in 2, ureter in 9, renal pelvis in 7 and calices in 3 patients. Surgical treatment included percutaneous nephrolithotomy in 1, cystoscopic lithotripsy in 3, flexible ureteroscopic lithotripsy in 6 and rigid ureteroscopic lithotripsy in 12 patients. No major complications were observed. One patient (4.5%) who underwent flexible ureteroscopy developed postoperative urinary tract infection. All patients were stone-free except two (9%) patients who required a second-look procedure after flexible ureteroscopic lithotripsy for residual stones. Stone recurrence was not observed in any patient during a mean follow-up duration of 30.2 months (range 8-84). Renal transplant lithiasis is uncommon and minimally invasive surgical treatment is rarely performed for its treatment. Endourological surgery may be performed safely, effectively and with a high success rate in these patients.

摘要

同种异体移植结石病是肾移植(RT)的一种罕见泌尿科并发症。我们旨在介绍我们在活体供肾移植受者系列中采用微创外科治疗同种异体移植结石病的经验。在对 2009 年 11 月至 2017 年 1 月期间在我们中心进行的 3758 例连续活体供肾 RT 的回顾性分析中,评估了随访时诊断为肾移植结石病的微创外科治疗结果。22 例(0.58%)患者因肾移植结石病而行微创外科手术。平均年龄为 41.6 岁,RT 与手术干预之间的时间为 27.3 个月(范围 3-67)。平均结石大小为 11.6 毫米(范围 4-29)。1 例位于尿道,2 例位于膀胱,9 例位于输尿管,7 例位于肾盂,3 例位于肾盏。手术治疗包括经皮肾镜取石术 1 例,膀胱镜碎石术 3 例,软性输尿管镜碎石术 6 例和硬性输尿管镜碎石术 12 例。未观察到重大并发症。1 例(4.5%)接受软性输尿管镜检查的患者发生术后尿路感染。除 2 例(9%)患者在软性输尿管镜碎石术后因残余结石需要再次检查外,所有患者均无结石。在平均 30.2 个月(范围 8-84)的随访期间,没有患者出现结石复发。同种异体移植结石病并不常见,很少采用微创外科治疗。在这些患者中,内镜手术可以安全、有效地进行,成功率高。

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