移植肾输尿管结石腔镜治疗.docVIP

移植肾输尿管结石腔镜治疗【摘要】 目的 探讨肾移植术后移植肾输尿管结石的腔镜治疗效果。方法 结合病史及文献对5例移植肾输尿管结石患者的临床资料进行系统性回顾分析,5例均行输尿管镜钬激光碎石术,其中结石直径为7~48 mm,接受肾移植术的时间约为7个月~9年。结果 4例行输尿管镜钬激光碎石术碎石成功;1例在碎石过程中,结石被冲洗液冲入肾盂,术后留置D J管行ESWL术,2次后排净结石。术后随访1~6年,人肾均存活良好,5例患者肾功能恢复正常,无结石复发。结论 移植肾输尿管结石处理应选择创伤小、效果好的腔镜微创治疗,尽而更好地保护肾功能。 【关键词】肾移植;尿路结石;内窥镜术 Endoscopic treatment of urinary calculi in allograft kidneys WANG Shen yang,SU Shun ye,ZHANG Yu fang,et al.Department of Urology,Shandong Peoples Hospital,the Affiliated Weifang People’s Hospital of Weifang Medical College,Shangdong Weifang 261041,China 【Abstract】 Objective To evaluate the effect of endoscopic treatment for urinary calculi in allograft kidneys.Methods The clinical files of urolithiasis in allograft kidneys in 5 cases were retrospectively analyzed consulting with literature,overall 5 cases of urinary calculi in allograft kidneys were treated by endoscopic technique.Among them,the stone size ranged from 8 mm to 48 mm in greatest dimension,and the time after transplantation ranged from 7 months to 9 years.Results YAG Lithotripsy by ureteroscopy was performed successfully in 4 cases;one underwent ESWL after failed ureteroscopy.The patients were followed up for 1~6 years,and all the patients and transplanted kidneys survived well.The kidney function returned to normal in 5 patients and no stones recurred.Conclusion Due to its less trauma and excellent outcome,minimally invasive endoscopy should be chosen for treatment of urinary calculi in allograft kidney so as to protect kidney function as far as possible. 【Key words】 Kidney transplantation;Urinary calculi;Endoscopy 移植肾尿路结石并不常见,其发病率约为0.2%~1.7%[1]。回顾性分析本院300余例肾移植受者的临床资料,其中术后发生移植肾结石者5例,约占肾移植受者的1.67%。由于移植患者病理生理的特殊性及移植肾尿路的解剖特点,临床上处理相对棘手。2003年1月至2008年8月,笔者采用腔镜治疗移植肾输尿管结石5例,效果满意,现报告如下。 1 资料与方法 1.1 一般资料 本组5例,男3例,女2例,年龄24~51岁,平均41岁。上段输尿管结石2例,下段输尿管结石3例。结石最大径7~48 mm。接受肾移植手术时间7个月~9年。5例患者均接受标准的同种异体肾移植手术,移植肾输尿管应用拖入式移植于膀胱同侧壁顶部,移植肾位于右侧4例、左侧1例,合并移植输尿管口狭窄1例。服用泼尼松、吗替麦考酚酯、环孢素A三联抗排斥治疗4例,泼尼松、他克莫司、环孢素A三联抗排斥治疗1例。术后2周内