肾移植后尿路并发症的发生及治疗:1223例次资料回顾

Occurrence and treatment of urological complications following renal transplantation:Data review in 1 223 cases

背景:尿路并发症是肾移植后常见外科并发症之一,严重危及移植肾功能,甚至患者生命。肾移植后尿路并发症主要包括尿瘘、输尿管梗阻、输尿管返流等。目的:回顾性分析肾移植后尿路并发症的发生及处理情况。方法:选择解放军第三军医大学大坪医院野战外科研究所泌尿外科于1993-12/2007-04开展的1223例次同种异体肾移植的临床资料,根据供肾输尿管情况及受者下尿路情况,尿路重建采用输尿管-膀胱黏膜下隧道吻合法948例次,输尿管-输尿管端端吻合法275例次。肾移植后发生的尿瘘、移植肾输尿管梗阻、膀胱输尿管根据不同原因采取相应处理方法,主要为外科治疗。分析尿路并发症的发生原因,观察治疗后移植肾功能变化,记录移植肾3年存活率。结果与结论:1223例次肾移植共发生尿路并发症92例(7.5%),其中尿瘘43例(3.5%),35例经再次手术治愈;输尿管梗阻35例(2.9%),29例经外科手术治愈;膀胱输尿管返流14例(1.1%),6例经外科手术治愈。70例行外科处理,其中移植肾输尿管-自体输尿管吻合35例(占50%),输尿管-膀胱重新再植18例(占25.7%),泌尿内镜治疗11例(占15.7%),其他手术6例(占9.6%)。除1例由于供肾肾盂、输尿管全段坏死行移植肾切除外,其余患者肾功能均得到恢复,未发生由于尿路并发症导致的移植肾丢失及患者死亡。出现尿路并发症及无尿路并发症移植肾3年存活率差异无显著性意义(P>0.05)。提示肾移植后尿路并发症大都需要外科处理,其中移植肾输尿管-自体输尿管吻合是常用术式,处理得当对移植肾远期存活率无明显影响。

BACKGROUND：Urological complication is one of common surgical complications following transplantation and severely threatens renal function,even patient＇s lives.Urological complications following renal transplantation mainly contain urinary fistula,ureteral obstruction and ureter backflow.OBJECTIVE：To retrospectively analyze the incidence and management of urological complications following kidney transplantation.METHODS：A total of 1 223 patient times following kidney transplants were selected at the Department of Urology,Institute of Surgery Research,Daping Hospital,Third Military Medical University of Chinese PLA from December 1993 to April 2007.According to ureter of donor kidney and the urinary tract of recipients,ureteroneocystostomy was used for urinary tract reconstitution in 948 patient times,and end-to-end ureteroureterostomy in 275 patient times.Urological complications such as urinary fistula,ureteral obstruction and vesicoureteral reflux（VUR）were treated by the different methods on the basis of the different causes,mainly by surgical procedures.Reason of urological complications,surgical management of urological complications and its clinical outcome,the 3-year survival rate of grafted kidney were measured.RESULTS AND CONCLUSION：In a total of 1 223 patients,urological complications were encountered in 92 cases（7.5%）,including 43 cases of urinary fistula（3.5%）,35 ureteral obstruction（2.9%）,14 VUR（1.1%）.35 cases of urinary fistula,29 ureteral obstruction,6 VUR were cured by surgical procedures including ureteroureterostomy in 35 patients（50%）,revision of ureteroneocystostomy in 18（25.7%）,endourology in 11（15.7%）and other operation in 6（9.6%）.All recipients with urological complications regained normal graft function except one undoing transplanted nephrectomy due to the pelvis and urteral necrosis.There was no grafted kidney and recipient loss secondary to these complications in the present series.The 3-year survival rate of graft with urological complications and without urological complications did not show significant difference（P 0.05）.These indicated that most of urological complications following kidney transplantation request surgical management,and ureteroureterostomy are frequently used.The long-term graft survival is not affected by a correctly treated urological complication.