Kashi S H, Irving H C, Sadek S A
University Department of Surgery, St James's University Hospital, Leeds, UK.
Br J Radiol. 1993 Oct;66(790):877-81. doi: 10.1259/0007-1285-66-790-877.
Significant pelvicalyceal dilatation in renal allografts is currently investigated by antegrade pyelography. However, the clinical significance of a radiologically demonstrated narrowing of the ureter is unclear. Over a 21-month period 26 of 155 renal allografts with pelvicalyceal dilatation were investigated by antegrade pyelography. In eight allografts no ureteric stenosis could be identified. Two grafts were shown to have ureteric necrosis and required surgical intervention and 16 of the other grafts appeared to have a ureteric stenosis. 15 of the 16 allografts with radiological ureteric stenosis underwent a concurrent pressure flow study to assess the functional relevance of the ureteric narrowing. As shown by a pressure rise of > 7 mmHg at a perfusion rate of 10 ml min-1, 11 of the 15 grafts were functionally obstructed and were treated by a nephrostomy catheter followed by antegrade insertion of a ureteric stent. The four grafts with a negative pressure flow study were subsequently shown on biopsy to have rejection. The diagnosis of allograft rejection was also confirmed by biopsy in seven of the eight allografts without a radiological ureteric stenosis. The last of the eight allografts was found to be cyclosporin toxic. Pelvicalyceal dilatation of renal allografts is appropriately investigated by antegrade pyelography in combination with a pressure flow study which identifies those grafts with mechanical obstruction.
目前，肾移植中显著的肾盂肾盏扩张通过顺行肾盂造影进行研究。然而，放射学显示的输尿管狭窄的临床意义尚不清楚。在21个月的时间里，对155例有肾盂肾盏扩张的肾移植患者中的26例进行了顺行肾盂造影检查。在8例移植肾中未发现输尿管狭窄。2例移植肾显示有输尿管坏死，需要手术干预，其他16例移植肾似乎有输尿管狭窄。16例放射学显示输尿管狭窄的移植肾中有15例同时进行了压力流研究，以评估输尿管狭窄的功能相关性。在灌注速率为10 ml/min时压力升高>7 mmHg，表明15例移植肾中有11例存在功能性梗阻，先置入肾造瘘导管，随后顺行置入输尿管支架进行治疗。压力流研究结果为阴性的4例移植肾随后经活检显示有排斥反应。在8例无放射学输尿管狭窄的移植肾中，有7例经活检也证实了移植肾排斥反应的诊断。8例移植肾中的最后1例被发现是环孢素中毒。肾移植的肾盂肾盏扩张通过顺行肾盂造影结合压力流研究进行适当的检查，压力流研究可识别出那些存在机械性梗阻的移植肾。
