肾移植术后漏尿的病因与治疗

目的：总结肾移植术后漏尿的病因、诊断、治疗与预防。方法：回顾分析１４５例肾移植术后４例发生漏尿病人的临床资料。结果：发生率２．７６％。１例术后早期漏尿保守治疗３周痊愈；１例输尿管多处坏死两次修补失败，保守治疗５周愈合；１例例输尿管膀胱吻合口坏死１例肾盂积水破裂一次修补成功。结论：外科技术失误是漏尿的主要原因，另外还与急性排异等有关，漏尿部位大多位于输尿管下端，也可发生于全程输尿管和肾盂，表现为尿外漏、肾周积液、少尿、腹腔积液。漏尿时间多发生在术后３周左右。急性排异引起者发生于排异控制后的多尿期，表现为尿量骤减，保守治疗适用于早期尿外漏及肾周积液者，３周以上不愈或漏尿有增多趋势者应手术探查修补，腹腔内大量积尿者应急诊手术，该并发症大多数是可以预防的。

Causes and Therapy of Urinary Leakage after Kidney Transplantation

Objective: We discussed the etiology, clinical manifestation, diagnosis, therapy and prognosis of urinary leakage after kidney transplantation. Methods: A retrospective analysis of 4 cases was reported. Results: The morbidity was 2. 67%. 1 case leaked in early stage after transplantation and was cured by 3 weeks conservatire treatment. 1 case of segmental ureter necrosis was cured by 5 weeks of conservation after failure of twice surgical repair. 1 case of visicoureterstomy leakage and 1 case of pelvis rupture were successfully repaired once. Conclusion: In addition to acute rejection,surgical technique remains the most important cause of urinary leakage. Most of them happended in visicoureterstomy, few in pelvis. Urinary fistulas, hydroperinephrosis, oliguria, or hydroperitoneum a re features of leakage. Most cases occurre in 3rd week after transplantation. When acute rejection is the cause, it happends in the polyuria phase after rejection being controlled and characterized by suddenly oliguria. Urinary fistulas and hydroperinephrosis can be cured by conservation, if it can not be acred or leakage progressing or with hydroperitoneum, surgical repair must be undertaken. Most of these complications can be prophylactic.