| Objective:In the treatment of urinary calculi in renal transplantation patients,because the transplanted kidney is a more precious isolated kidney.and the transplantation operation opportunity is rare,it has particularity,so special attention should be paid to the protection of transplanted kidney function in the treatment.At the same time,the changes of the anatomical structure of transplanted kidney and ureter have some specificity in treatment,which increases the difficulty of treatment.By analyzing the data of diagnosis and treatment of upper urinary tract calculi in transplanted kidney,we summarized our experience and discussed the influence of related factors on long-term renal function in patients with upper urinary tract calculi in transplanted kidney.Methods:From January 2005 to October 2017,27 patients with transplanted kidney,ureteral calculi and 10 patients with calculi transplanted in other hospitals in the follow-up system of two kidney transplantation centers of the General Hospital of Northern Liaoning Province and the General Hospital of Anshan Iron and Steel Group Company were retrospectively reviewed.A total of 37 patients were diagnosed and treated.Age ranged from 23 to 62 years old;male,27 cases,female,10 cases;preoperative primary diseases were glomerulonephritis,diabetic nephropathy,hypertensive nephropathy,polycystic kidney disease and unexplained renal insufficiency.The onset time of calculi after kidney transplantation is 1 to 10 years.Renal allograft transplantation was performed in 33 cadaveric kidney transplantation.1 related kidney transplantation and 3 brain dead organ donation.The transplanted kidney was located in the right iliac fossa.The transplanted renal artery and vein were anastomosed end to side with the external iliac artery and vein.The ureter of the transplanted kidney and the bladder wall were anastomosed with the bladder submucosal anti-reflux anastomosis.Thirty-one patients were treated with ureteral stent during operation,and the immunosuppressive regimen after operation was routinely combined with calmodulin inhibitor,antiproliferative drug and glucocorticoid.Creatinine levels ranged from 56 mmol/1 to 512 nmol/1.The stones were located in the kidney in 15 cases,in the upper ureter in 14 cases,in the lower ureter in 6 cases,and in the transplanted kidney and ureter in 2 cases.The main causes of calculi are:secondary calculi of ureteral stent,donor kidney calculi,infection,ureteral stricture,hyperuricemia,immunosuppressive agents,secondary hyperparathyroidism,etc.Treatment methods include conservative treatment,open surgery,extracorporeal shock wave lithotripsy,percutaneous nephrolithotripsy,ureteroscopic holmium laser lithotripsy,ureteral stent placement and combined treatment.Among the 37 patients.18 underwent percutaneous nephrolithotomy,of which 3 undervvent percutaneous nephrostomy at the first stage because of infection.After infection was controlled by drainage,1 underwent percutaneous nephrolithotomy combined with ureteroscopic lithotripsy,8 underwent ureteroscopic holmium laser lithotripsy,5 underwent conservative treatment,and 4 underwent extracorporeal shock wave lithotripsy to remove stones.Ureteral stent was placed before lithotripsy in 1 case,ureterolithotomy in 1 case,and simple stent placement in 1 case combined with drug therapy.After treatment,creatinine decreased significantly and renal function gradually recovered.Follow-up period ranged from 6 months to 1 year.Sixteen patients recovered to normal after 6 months of treatment,and 21 patients had creatinine of 150 umol/1.After 1 year of treatment,creatinine remained basically at the level of 6 months after treatment.Five patients had recurrence of small stones about 1 year after treatment.Immunosuppression was based on age.sex,site of calculi,obstruction time,preoperative creatinine level,treatment method,placement of ureteral stent,postoperative hematuria,formation of stone street,recovery of renal function.recurrence,resistance index of renal artery and thickness of renal parenchyma.The application of the preparation was grouped into tables and database,and the recovery level of creatinine was followed up.Data were collected and analyzed by SPSS 19.0 software.The long-term recovery of renal function in patients with upper urinary tract calculi after kidney transplantation was analyzed by t-test single factor statistics and logistic regression multivariate analysis.Result:According to the results of single factor analysis of t test,gender,age.treatment method,placement of ureteral stent,post-operative infection,post-operative stone street,post-operative creatinine and post-operative recurrence had little effect(P>0.05).Preoperative creatinine,vascular resistance index of transplanted renal artery.obstruction site of calculi,placement of ureteral stent or not,and thickness of transplanted renal parenchyma had significant differences in the long-term functional recovery of transplanted kidney(P<0.05).which indicated that these factors could affect the functional recovery of transplanted kidney.Logistic multivariate regression analysis showed that preoperative creatinine and renal artery resistance index were independent risk factors for long-term renal function recovery.Conclusion:The treatment of upper urinary tract calculi in kidney transplantation is similar to that of conventional calculi.Each method has its own advantages and disadvantages.Appropriate treatment should be selected according to the condition of the kidney transplantation,and the obstruction should be removed as soon as possible,and the protection of the function of the kidney transplantation should be paid attention to.According to the statistical results,preoperative creatinine,the location of stone obstruction,vascular resistance index of renal artery,whether to place ureteral stent or nrot,and the thickness of renal parenchyma can affect the long-term renal function recovery of transplanted kidney.Preoperative creatinine and vascular resistance index were independent risk factors for long-terrn rerial function recovery. |
PDF Full Text Request