中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2010年
18期
3373-3376
,共4页
李香铁%杨先振%张爱民%郝俊文%李慎勤%刘少鸽%徐友和%刘仰东%刘毅%宋华%石岩%沈弋帧%林长胜
李香鐵%楊先振%張愛民%郝俊文%李慎勤%劉少鴿%徐友和%劉仰東%劉毅%宋華%石巖%瀋弋幀%林長勝
리향철%양선진%장애민%학준문%리신근%류소합%서우화%류앙동%류의%송화%석암%침익정%림장성
肾移植%输尿管%梗阻%再植%器官移植
腎移植%輸尿管%梗阻%再植%器官移植
신이식%수뇨관%경조%재식%기관이식
背景:输尿管梗阻的发生原因有外科技术性、缺血性、周围病变压迫和排斥反应等,其中外科因素最为重要.如何有效降低肾移植后输尿管并发症的发生,并对其作出及时诊断、处理对临床有重要的指导意义.目的:回顾解放军济南军区总医院23例肾移植后输尿管并发症的诊治情况,分析总结肾移植后输尿管并发症的发病原因及防治经验.方法:回顾分析解放军济南军区总医院1998-01/2008-12肾移植患者1 160例的临床资料,肾移植后发生输尿管并发症23例,占1.98%.其中尸体供肾移植共924例,发生移植肾输尿管并发症18例,占1.95%;活体供肾移植236例,发生移植肾输尿管并发症5例,占2.12%.17例行移植肾输尿管膀胱重新吻合术;2例行移植肾输尿管-自体输尿管吻合术;1例行输尿管皮肤造瘘术;1例行移植肾输尿管游离,重新放置输尿管支架管;1例行球囊扩张术;1例行软膀胱镜下逆行输尿管支架管插管治疗.输尿管并发症治疗后复查B超明确肾盂输尿管扩张恢复情况.结果与结论:23例患者中19例为输尿管膀胱吻合口狭窄,2例输尿管坏死,2例输尿管扭曲.治疗后随访3～98个月,其中20例患者经手术治疗,恢复了移植肾肾盂与膀胱的通畅,移植肾功能均有明显的改善,术后4 d内血肌酐浓度下降,术后无复发.1例皮肤造瘘患者术后8年余,移植肾功能正常,定期更换造瘘管.1例扩张及1例留置输尿管支架管患者治疗后效果欠佳,仍输尿管狭窄,后行手术治疗.提示肾移植后输尿管梗阻病因复杂,以输尿管膀胱吻合口狭窄最常见;外科手术是解除梗阻的主要方法,经及时恰当的外科处理,对移植肾功能的恢复及长期存活无明显影响.
揹景:輸尿管梗阻的髮生原因有外科技術性、缺血性、週圍病變壓迫和排斥反應等,其中外科因素最為重要.如何有效降低腎移植後輸尿管併髮癥的髮生,併對其作齣及時診斷、處理對臨床有重要的指導意義.目的:迴顧解放軍濟南軍區總醫院23例腎移植後輸尿管併髮癥的診治情況,分析總結腎移植後輸尿管併髮癥的髮病原因及防治經驗.方法:迴顧分析解放軍濟南軍區總醫院1998-01/2008-12腎移植患者1 160例的臨床資料,腎移植後髮生輸尿管併髮癥23例,佔1.98%.其中尸體供腎移植共924例,髮生移植腎輸尿管併髮癥18例,佔1.95%;活體供腎移植236例,髮生移植腎輸尿管併髮癥5例,佔2.12%.17例行移植腎輸尿管膀胱重新吻閤術;2例行移植腎輸尿管-自體輸尿管吻閤術;1例行輸尿管皮膚造瘺術;1例行移植腎輸尿管遊離,重新放置輸尿管支架管;1例行毬囊擴張術;1例行軟膀胱鏡下逆行輸尿管支架管插管治療.輸尿管併髮癥治療後複查B超明確腎盂輸尿管擴張恢複情況.結果與結論:23例患者中19例為輸尿管膀胱吻閤口狹窄,2例輸尿管壞死,2例輸尿管扭麯.治療後隨訪3～98箇月,其中20例患者經手術治療,恢複瞭移植腎腎盂與膀胱的通暢,移植腎功能均有明顯的改善,術後4 d內血肌酐濃度下降,術後無複髮.1例皮膚造瘺患者術後8年餘,移植腎功能正常,定期更換造瘺管.1例擴張及1例留置輸尿管支架管患者治療後效果欠佳,仍輸尿管狹窄,後行手術治療.提示腎移植後輸尿管梗阻病因複雜,以輸尿管膀胱吻閤口狹窄最常見;外科手術是解除梗阻的主要方法,經及時恰噹的外科處理,對移植腎功能的恢複及長期存活無明顯影響.
배경:수뇨관경조적발생원인유외과기술성、결혈성、주위병변압박화배척반응등,기중외과인소최위중요.여하유효강저신이식후수뇨관병발증적발생,병대기작출급시진단、처리대림상유중요적지도의의.목적:회고해방군제남군구총의원23례신이식후수뇨관병발증적진치정황,분석총결신이식후수뇨관병발증적발병원인급방치경험.방법:회고분석해방군제남군구총의원1998-01/2008-12신이식환자1 160례적림상자료,신이식후발생수뇨관병발증23례,점1.98%.기중시체공신이식공924례,발생이식신수뇨관병발증18례,점1.95%;활체공신이식236례,발생이식신수뇨관병발증5례,점2.12%.17례행이식신수뇨관방광중신문합술;2례행이식신수뇨관-자체수뇨관문합술;1례행수뇨관피부조루술;1례행이식신수뇨관유리,중신방치수뇨관지가관;1례행구낭확장술;1례행연방광경하역행수뇨관지가관삽관치료.수뇨관병발증치료후복사B초명학신우수뇨관확장회복정황.결과여결론:23례환자중19례위수뇨관방광문합구협착,2례수뇨관배사,2례수뇨관뉴곡.치료후수방3～98개월,기중20례환자경수술치료,회복료이식신신우여방광적통창,이식신공능균유명현적개선,술후4 d내혈기항농도하강,술후무복발.1례피부조루환자술후8년여,이식신공능정상,정기경환조루관.1례확장급1례류치수뇨관지가관환자치료후효과흠가,잉수뇨관협착,후행수술치료.제시신이식후수뇨관경조병인복잡,이수뇨관방광문합구협착최상견;외과수술시해제경조적주요방법,경급시흡당적외과처리,대이식신공능적회복급장기존활무명현영향.
BACKGROUND: Ureteral obstruction is mainly caused by surgical technic, ischemic, and peripheral lesion compression as well as rejection; in particular, the surgical technic factor is the most important. How to effectively reduce ureteral complications following renal transplantation is significant for prompt diagnosis and clinical treatment.OBJECTIVE: To retrospectively analyze the diagnosis of 23 cases with ureteral complications following renal transplantation, and to summarize pathogeny and preventing management.METHODS: The retrospective analysis was conducted on 23 (1.98%) out of 1 160 cases with ureteral complications following renal transplantation who were selected from General Hospital of Jinan Military Area Command of Chinese PLA from January 1998 to December 2008. In 924 cases of renal transplantation with cadaver kidneys, ureteral stenosis occurred in 18 cases (1.95%), while in 236 cases with relative kidneys, ureteral stenosis occurred in 5 cases (2.12%). A total of 17 cases were performed with ureterovesicostomy; 2 with uretero-autoallergic anastomosis of ureter; 1 with cutaneous ureterostomy; 1 with ureteral liberation, resetting ureteric branch stand; 1 with saccule dilation; 1 with retrograde ureteric branch stand under cystoscope. Type-B ultrasonic examination was re-checked to determine pyeloureterectasis following treating ureteral complications.RESULTS AND CONCLUSION: Of the 23 cases, stenosis of ureterovesical junction occurred in 19 cases, necrosis of the ureter on 2 cases, and twisting of ureter graft on 2 cases. Following up was performed after treatment for 3-98 months. In 20 cases, renal pelvis and urinary bladder of transplanted kidney were smooth, and function was recovered remarkably. At 4 days after surgery, serum creatinine level was decreased, and no recurrence was rechecked postoperatively. One patient had skin stoma for 8 years at least postoperatively, and the renal function was still normal. The skin stoma was replaced regularly. Therapeutic effect was poor in a patient with distension and 1 with detaining ureteric branch stand, and patients still had stricture of ureter,which was treated by a surgery. The results demonstrated that the etiology of ureteral obstruction after kidney transplantation was complex, and stenosis of ureterovesical junction was most common. Most of obstruction request surgical management. The graft function and the long-term graft survival were not affected by a correctly treated ureteral obstruction.
