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。观察肾移植后尿瘘病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 3-31 days after renal transplantation, and the amount was 60-2 000 mL per day. Based on the principle of the urethral injury classification method, urethral fistula was divided into simple and complex categories, while according to the fistula site, etiology and extent, urethral fistula was divided into low, high and multiple fistula. Attack rate of simple urethral fistula and complex urethral fistula was detected following renal transplantation so as to analyze the pathogeny of urethral fistula. RESULTS AND CONCLUSION: Of 68 cases with urethral fistula following renal transplantation, 47 cases (69.1%) were simple urethral fistula, including 42 cases with ureteral end necrosis, 4 cases with lax anastomotic suture of ureter bladder, and 1 case with ureteral anastomotic badness caused by wound infection, and 21 cases (30.9%) were complex urethral fistula, including 2 cases with renal pelvis fistula, 2 cases with ureter, 11 cases with ureterovesical anastomosis region, 6 cases with ureteral necrosis longer than 2 cm. A lot of causes may induce urethral fistula following renal transplantation. The blood stream, edema, size of fistula, length of the ureter, and operative procedures are selected to ensure free of strain. Urethral fistula can be treated on time on the basis of different situations.