肾移植术后尿瘘的病因诊断及处理对策

目的：探讨肾移植术后尿瘘的病因诊断及处理对策，以降低肾移植术后患者尿瘘发病率及死亡率。方法：回顾性分析2003年1月～2007年12月以来行340例次肾移植术后出现尿瘘的原因及其积极正确的诊断与治疗经验，以挽救移植肾功能及患者生命。结果：340例次肾移植中，确诊尿瘘15例次，发生率为4．4％，发生时间5～24天，平均15天。根据诊断及临床特征行保守治疗和手术治疗等，恢复功能14例，治愈率为93．3％；死亡1例。死亡率为6．7％。结论：尿瘘是肾移植后主要并发症之一，发生原因各异，排斥反应及血供损伤是主要原因。加强抗排斥反应，防止血供损伤，作抗反流乳头吻合，常规内置双J管，可以减少其发生；早期诊断及个体化治疗方案是其治愈的关键。

The Diagnosis and Treatment of Urinary Fistula After Kidney Transplantation

Objective：To discuss the diagnosis and treatment of urinary fistula after renal transplantation, and to lower incidence and mortality of urinary fistula. Methods： From 2003 Jan. to 2007 Dec, the reasons and their positive experience in the diagnosis and treatment of 340 cases with urinary fistula after renal transplantations were reviewed, in order to save renal function and lives of patients. Results：In 340 cases renal transplantations, 15 cases were diagnosed as urinary fistula, the incidence of urinary fistula was 4.4% , occurred in 5 to 24 days with mean time 15 days. Conservatively or surgically treatment in 15 cases with success in 14（93.3%）,1（6.7%） lost graft and dead. Conclusions：Urinary fistula is a frequency complication after renal transplantation leading to graft losses and patient death. To strengthen the anti--rejection response and prevent the damage of blood supply, the extra vesical ureteroneocystostomy and a I〉J stent seems feasible to minimize urinary fistula. Early diagnosis and per sonally treatment are the key.