肾移植10年514例术后尿瘘23例:分类及治疗

Classification and treatment of urinary fistulas following renal transplantation:A 10-year summary of 514 cases

对解放军成都军区总医院1998-12/2008-12肾移植后出现尿瘘23例患者的病因、诊断及治疗结果进行回顾性分析。23例中行1次肾移植21例,2次2例;吻合方式9例采用肾动、静脉与髂外动、静脉端侧吻合,14例采用肾动脉与髂内动脉,肾静脉与髂外静脉吻合。23例患者随访6～12个月,17例为移植后3～7d发生尿瘘,6例为移植后7～10d发生;17例为吻合口瘘,4例为输尿管远端坏死,2例为肾盂瘘。保守治疗11例,手术治疗12例。手术患者中,9例采用常规手术方法的患者有1例再次出现尿瘘,经二次手术后治愈;3例采用带蒂大网膜修补法,尿瘘无复发,移植肾B超检查无积水,患者肾功能正常。手术一次成功率92%(11/12),其中采用带蒂大网膜修补法成功率为100%。提示尿瘘最重要的是预防,从取肾、修肾到手术中都要注意保护输尿管,同时注意输尿管与膀胱的吻合技巧,避免因手术原因导致吻合口瘘,这样才能减少尿瘘的发生,同时一旦出现尿瘘后应根据不同情况及时处理,这样才能最大程度减少尿瘘对移植肾功能的损害。

The etiological factor,diagnosis,as well as therapeutic results of 23 cases with urinary fistula following renal transplantation,at the Chengdu Military General Hospital,from December 1998 to December 2008,were analyzed retrospectively,including 21 cases with a renal transplantation,2 cases with retransplantation;9 cases adopt renal artery,renal veins to external iliac artery,external iliac vein anastomosis,14 cases with renal artery to internal iliac artery,renal veins to external iliac vein anastomosis.23 cases were followed-up for 6-12 months,17 cases suffered urinary fistula at days 3-7 after transplantation,6 cases occurred at days 7-10;there were 17 stoma fistulae,4 distal end necrosis of ureter,2 ureteral fistulae.11 cases were received conservative treatment,and 12 cases with operation.Among the surgery patients,9 cases received conventional operation and 1 of them returned with urinary fistula and then was cured by second operations;3 patients received pedicled omentum transplantation and no recurrence or hydronephrosis happened with normal renal function.The one-time success rate was 92%（11/12）,of which the repair success rate using pedicled omental was 100%.The results demonstrated that prevention plays an important role in urinary fistula,and ureter should be protected during the surgery.Meanwhile,stoma fistula should be avoided.Promptly treatment following urinary fistula is also necessary to reduce the damage of urinary fistula to the renal function.