肾移植术后尿瘘病因68例分析

背景:肾移植后并发尿瘘占泌尿系并发症的40%～70%,其尿瘘的可能诱因包括外科因素和内科因素两个方面.目的:有效减少和避免同种异体.肾移植后尿瘘的发生,延长移植肾的存活.方法:从病因、诊断和处理方面回顾分析68例肾移植患者术后尿瘘的临床资料,其中男47例,女21例,年龄20～58岁,肾移植后尿瘘发生时间为3～31 d, 每日漏尿量60～2 000 mL.参照尿道损伤分类标准,按照尿瘘病变程度分为单纯性和复杂性两大类,按照尿瘘的病因及部位分为低位瘘、高位瘘和多发瘘.观察肾移植后尿瘘炳例中单纯性和复杂性尿瘘各自发生概率,分析尿瘘的病因.结果与结论:68例肾移植患者术后尿瘘中,47例为单纯性尿瘘,占69.1%,其中输尿管末端坏死42例,输尿管膀胱吻合口缝合不严4例,伤口感染致吻合口愈合不良1例;复杂性尿瘘21例,占30.9%,其中肾盂瘘2例,输尿管瘘2例,输尿管膀胱吻合口瘘11例,输尿管坏死段大于2 cm 6例.肾移植的任何步骤处理不当都可引起术后尿瘘,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.发生尿瘘后要根据不同情况及时处理.

Pathogeny of urethral fistula after renal transplantation:A 68-case analysis

BACKGROUND:Urethral fistula following renal transplantation accounts for 40%-70% of urinary complications,owing to surgical and medical factors.OBJECTIVE:To effectively decrease and avoid attack of urethral fistula after renal transplantation,and prolong the survival of kidney.METHODS:Clinical data from 68 cases following renal transplantation were retrospectively analyzed at the levels of pathogeny,diagnosis and treatment.There were 47 males and 21 females,aging 20-58 years.Urethral fistula occurred at 3-3...