外科医学论文：肾移植术后移植肾输尿管结石的诊断与治疗.doc

肾移植术后移植肾输尿管结石的诊断与治疗 杨伟锋 苏泽轩 王可兵 夏宏辉 方建明 丁泓文 陈洁 摘要：目的 探讨肾移植术后移植肾尿路结石的诊治策略。方法 回顾我院1995-2007年间肾移植病人术后发生移植肾上尿路结石的患者共15例，其中移植肾结石11例，输尿管结石4例。结果 11例移植肾结石中，2例行体外冲击波碎石术，患者术后短期血尿，血肌酐升高，8例行经皮肾镜取石术，完全取净结石，1例口服药物治疗，顺利排出结石，4例输尿管结石中，2例行经皮肾镜取石术，成功取净结石，2例行输尿管镜取石术，1例成功取干净结石， 1例中转经皮肾镜取石术，成功取净结石。结论 经皮肾镜取石术在移植肾上尿路结石中疗效确切，安全，逆行输尿管镜取石术可作为选择方法。 关键词：肾移植; 结石; 经皮肾镜 The diagnosis and treatment of stones in transplanted kidneys and ureters 1.YANG Wei-feng,Wang Ke-bing,Xia Hong-hui, Fang Jian-ming.Department of Urology,the Sixth Hospital of Shenzhen City,Guangdong 518052, China;2. SU Ze-xuan,Ding Hong-wen,Chen Jie .Department of Urology,the First Affiliated Hospital,Jinan University, Guangzhou,Guangdong 510630,China Abstract： Objective　To study the diagnosis and treatment of stones in patients after renal transplantation Methods 　we retrospectively reviewed our patients who had performed renal transplantation from 1995 to 2007 and identified 15 patients who had stones in transplanted kidney or ureters. Results Two renal stones cases was treated with extra shock wave lithotripsy（ESWL）and stones disappeared;8 patients with renal stones were treated with minimally percutaneous nephrostolithotomy(mini-PCNL) successfully,1 case was treated with medicines and stone disappeared;Mini-PCNL was performed in 2 cases with ureteral stones successfully,ureteroscopic lithotomy(URL) were performed in 2 cases.of these 2 cases,1 cases was performed successfully,1 case was performed mini-PCNL after failed URL Conclusions mini-PCNL is a safe and effective means to patients with transplanted kidneys and ureters stones.URL can be chosen for treatment of ureter stone by experienced doctor. Key words：Renal Transplantation;　stone; PCNL 随着肾移植技术的成熟，新型免疫抑制剂的应用，器官捐献者的增多，带肾生存的肾移植病人的数量不断增加,移植肾输尿管发生结石的病例较前显著增加，引起了移植界的高度重视。 资料与方法 一、临床资料 暨南大学附属第一医院1995－2007年间共施行肾移植手术750多例，在回访的病人中共发生移植肾上尿路结石15例，男性10例，女性5例，移植肾结石11例，输尿管结石4例，年龄结构20－58岁,平均36.7岁，发病时间为肾移植术后2月－7年,平均42.5个月，结石的最大直径4－45mm，移植肾放置在右髂窝12例，左髂窝3例；输尿管抗返流吻合于同侧膀胱顶部；术后常