肾移植术后尿瘘的治疗策略研究(附72例报告)

Research on therapeutic strategies for urinary fistula after renal transplantation: a report of 72 cases

目的探讨肾移植术后尿瘘并发症的治疗策略。方法回顾性分析2008年6月至2012年12月在解放军第309医院全军器官移植研究所接受同种异体肾移植术的1 228例患者中,术后发生尿瘘的72例患者的临床资料。结果本组尿瘘发生率为5.86%。患者确诊后,首先保持输尿管支架管留置状态,并采取留置Foley导尿管的方法,在确认无效后在原创口或引流口置入普通导尿管或乳胶管引流,最后采取手术治疗,均采用无张力吻合。72例尿瘘患者中,46例经保守治疗后治愈,26例保守治疗无效后采用手术治疗,其中12例行瘘口修补术+留置膀胱Foley导尿管、10例行输尿管-膀胱重新吻合术+置入输尿管支架治愈,4例行输尿管-膀胱肌瓣吻合术无效后,行自体输尿管-移植肾输尿管吻合术后治愈。2例出现局部伤口感染,经加强引流及抗感染治疗后治愈。结论肾移植术后尿瘘预防胜于治疗,早期诊断、正确选择治疗措施是成功救治的关键。患者确诊后,首先采用保守治疗,确认无效后采取手术治疗,遵循无张力吻合原则。

Objective To investigate the therapeutic strategies for urinary fistula after renal transplantation. Methods Among the 1 228 patients who received allogenic renal transplantation in Institute of Organ Transplantation, the 309th Hospital of Chinese People＇s Liberation Army from June 2008 to December 2012, clinical data of 72 patients with urinary fistula after renal transplantation were analyzed retrospectively. Results The incidence of urinary fistula in this group was 5.86%. After the patients were diagnosed, the ureteral stents were kept indwelled firstly by the way of keeping Foley catheter. Common catheter or Latex tube were placed in the original wound or drainage outlet for drainage when the above therapy was ineffective. Surgical treatment was performed at last and tension-free anastomosis was taken. Among the 72 patients with urinary fistula, 46 cases were cured by conservative treatment. And 26 cases received surgical treatment after failed conservative treatment, in which 12 cases received repairment of fistula and placement of Foley catheter in the bladder, 10 cases were cured after receiving ureter-bladder anastomosis ＋ ureteral stent placement, and 4 cases were cured by receiving autologous ureter-transplant kidney ureter anastomosis after failure of ureter- bladder muscle flap anastomosis, Two cases suffered from partial wound infection and were cured after enhancing drainage and anti-infective therapy. Conclusions Prevention is prior to treatment for urinary fistula after renal transplantation. The key to successful treatment is early diagnosis and proper choice of therapy. Once the diagnosis is confirmed, conservative treatment is given preferentially, then surgical treatment is taken when the conservative treatment is failed. The principle of tension-free anastomosis should be followed.