带蒂大网膜移植修补肾移植术后复杂性尿瘘

Pedicled omentum grafts for the repair of complex urinary fistulas after renal transplantation

目的探讨带蒂大网膜移植修补肾移植术后复杂性尿瘘的应用价值。方法肾移植术后尿瘘行多次手术失败的患者21例，年龄23-55岁，平均32岁。尿瘘瘘口部位：肾盂2例，输尿管2例，输尿管膀胱吻合口11例，输尿管末端坏死6例。肾盂瘘切除瘘口后局部修补再用带蒂大网膜移植覆盖，输尿管瘘、输尿管膀胱吻合瘘或输尿管长段坏死者在行移植肾输尿管与自体输尿管对端吻合或与膀胱再植后用带蒂大网膜包绕于吻合口。结果21例患者手术一次成功20例（95％），失败1例（5％）。手术时间75-120min，平均95min。术中失血100-550ml。平均310ml。失败原因为伤口感染导致大网膜坏死而切除移植肾。随访1-7年，尿瘘无复发，吻合口无狭窄、肾积水及尿路感染，肾功能正常。结论利用大网膜的生物学特性，采用带蒂大网修补肾移植术后复杂性尿瘘取材方便，组织修复快，尿瘘复发率低，一次成功率高。

Objective To discuss the method of the pedicled omentum grafts for the repair of urinary fistulas after renal transplantation. Methods Twenty-one cases of urine fistulas after renal transplantation were treated with pedicled ornentum grafts. The average age was 32 years old（range, 23 to 55 years）. Of them, 2 cases had pelvis leakage,2 cases had ureter leakage, 11 cases had ureterbladder anastomosed site leakage, 6 cases had the necrosis of ureteral end. Pedicled omentum grafts were used to cover or surround the anastomosed site after pelvis fistula resection, ureterocystostomy or uretero-ureterostomy forming a protection barrier. Results Twenty of the 21 cases were operated successfully（95%）. Only 1 case（5%） failed because of the necrotic omentum after wound infection, and the kidney was resected consequently. Within the 1-7 years＇ follow up, there was no recurrence of urinary and stenosis, hydronephrosis and infection. The renal function remained normal. Conclusions Using pedicled grafts for the repair of complex urinary fistulas could be a choice for treating urinary fistula after kidney transplantation.