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目的评价微通道经皮肾穿刺造瘘在处理移植肾输尿管并发症中的应用价值。方法对5例移植肾输尿管尿瘘患者、2例移植肾输尿管狭窄患者及2例移植肾输尿管结石患者分别行微通道经皮肾穿刺造瘘,其中2例输尿管狭窄患者同期行DJ管置入术,2例输尿管结石患者行经皮肾镜碎石取石+DJ管置入术。待全身及局部情况改善后,根据影像检查结果决定是否行二期手术。结果 2例尿漏患者及1例输尿管狭窄患者经充分引流后治愈;1例尿瘘患者行二期移植肾输尿管与自体输尿管端端缝合术,2例尿漏及1例输尿管狭窄患者二期行移植肾输尿管膀胱再植术;输尿管结石患者拔除DJ管后未再出现输尿管梗阻表现。手术均取得成功,9例患者血肌酐水平出现不同程度的下降,随访4～79个月无复发。结论微通道经皮肾穿刺造瘘处理移植肾输尿管并发症安全有效,可避免开放手术或为开放手术提供一个有利的手术时机。
Objective To evaluate the value of microchannel percutaneous nephrostomy in the treatment of ureter complications of transplanted kidney. Methods Micro-channel percutaneous nephroureterectomy was performed in 5 patients with transplanted renal ureteric fistula, 2 patients with transplanted renal ureteral stricture and 2 patients with transplanted renal ureterolithiasis. Two patients with ureteral stricture underwent DJ catheterization during the same period, 2 cases of ureteral calculi in patients with percutaneous nephrolithotomy lithotripsy + DJ tube placement. After the improvement of the whole body and the local situation, the second phase operation is decided according to the result of the image examination. Results Two patients with urinary leakage and one patient with ureteral stricture were cured by adequate drainage. One patient with urinary fistula underwent second-stage renal transplantation and autologous ureteral end suturing, two patients with urinary leakage and one patient with ureteral stricture underwent second-stage transplantation Renal ureter bladder replantation; ureteral calculi removed after the removal of ureteral obstruction did not appear in the performance of ureteral obstruction. Surgery was successful, nine patients showed varying degrees of serum creatinine decline, followed up for 4 to 79 months without recurrence. Conclusion Micro-channel percutaneous nephrostomy is a safe and effective method for the treatment of ureteral complications in renal transplant recipients, which can avoid open surgery or provide a favorable timing for open surgery.