移植肾输尿管膀胱的吻合口瘘

Ureteral fistula after kidney transplantation

目的 有效地减少或避免同种异体肾移植术后移植肾输尿管膀胱吻合口瘘 ,延长移植肾的存活期。 方法 从病因、诊断和处理方面回顾性分析 30例肾移植患者术后移植肾输尿管膀胱吻合口瘘的临床资料。 结果 4例采用保守治疗 ,2例做单纯瘘口修补。 11例切除血供差、水肿严重的移植肾输尿管远端 ,或调整移植肾的位置 ,做移植肾输尿管膀胱再吻合。 13例膀胱翻瓣后 ,用2 0～ 2 4Foley尿管连接供肾的肾盂和受者膀胱瓣 ,其中 9例无法实现残留的移植肾输尿管与膀胱瓣无张力的间断缝合 ,只能待移植肾肾盂或上段输尿管沿Foley尿管爬行 ,形成隧道。受者 1年存活率96 7% (2 9/ 30 ) ,移植肾 1年存活率为 86 7% (2 6 / 30 )。 结论 肾移植的任何步骤处理不当都可以引起移植肾输尿管膀胱吻合口瘘 ;术中应根据输尿管血液供应 ,水肿情况 ,瘘口大小和输尿管的长度来选择不同的术式 ,以确保无张力的可靠吻合。

Objective To study pathogeny, diagnosis and treatment of ureter fistula after renal transplantation. Methods The clinical data from 30 cases after renal transplantations were analyzed. Results Four patients received conservative treatment, and 2 repairment of the fistula. Eleven patients had resection of the ureter or adjustmen of the kidney, followed by the anastomosis of the ureter and bladder again. After the turning of the bladder′s lamella, 13 patients were given 20 24 Foley′s tube connecting the pelvis and bladder and nine of them were not subjected to re anastomosis waiting for the pelvis crawling to the bladder as a tunnel. The one year survial rates for 30 cases and kidneys was 96.7% (29/30) and 86.7%(26/30) respectively. Conclusions There a lot of causes for ureter which are fistula, running related to every aspect of transplantation. Early diagnosis and treatment is important to prognosis. Most patients need reanastomosis. According to the blood stream, edema, length of the ureter, operative procedures are selected to ensure free of strain.