1223例次肾移植尿路并发症分析

目的 总结1223例次肾移植尿路并发症发生及处理情况.方法 1223例次肾移植历路重建方式采用输尿管膀胱吻合法948例次,输尿管输尿管吻合法275例次,分别总结两组术后尿瘘、输尿管梗阻、膀胱输尿管反流、尿路感染等常见尿路并发症发生及处理情况.结果 共发生尿层路并发症217例(17.7%),其中尿瘘43例(3.5%),输尿管梗阻35例(2.9%),膀胱输尿管反流14例(1.1%),尿路感染125(10.2%)例.输尿管膀胱吻合组共184例(19.4%),其中尿瘘39例(4.1%)输尿管梗阻22例(2.3%)、膀胱输尿管反流14例(1.5%)、尿路感染109例(11.5%),输尿管输尿管吻合组共33例(12.0%),其中尿瘘4例(1.5%)、输尿管梗阻13例(4.7%)、膀胱输尿管反流0侈(0%)、尿路感染16例(5.8%),两组比较差异均有统计学意义(均P＜0.05或均P＜0.01).外科处理并发症70例.出现尿路并发症及无尿路并发症组3年移植肾存活率分别为82.3%和84.7%.结论 输尿管输尿管吻合可降低肾移植术后尿路并发症的发生,外科处理并发症得当对移植肾远期其存活率无明显影响.

Urological complications in 1 223 kidney transplants

Objective To review retrnspectively the urological complications in 1 223 kidney transplants.Methods A total of 1 223 kidney transplants were divided into ureteroneoeystostomy group (n = 948) and ttreteronreterostomy group (n = 275 ) according to the methods of urinary tract reconstruction.The incidence and management of urological complications such as urinary fistula,obstruction of ureter,vesicoureteral reflux (VUR) and urinary tract infection ( UTI) were summarized respectively.Results Overall,urological complications were encountered in 217 ( 17.7% ) cases,including 43 cases of urinary fistula (3.5%),35 obstruction of ureter(2.9%),14 VUR(1.1%) and 125 UTI (10.2%).Urinary fistula was 39(4.1% ) eases and 4 cases (1.5% ) (P ＜ 0.05 ),obstruction of ureter 22 (2.3%) & 13 (4.7%)(P＜0.05),VUR 14(1.5%)& 0(0%)(P＜0.05)and UTI 109 (11.5%)& 16(5.8%)(P＜0.01 ) in the ureteroneocystostomy group and reteroureterostomy group respectively.Seventy patients underwent surgical treatment.The 3-year survival rate of graft with urological complications and without urological complications were 82.3% and 84.7% respectively.Conclusions Ureteroureterostomy can decrease the incidence of urological complications after kidney transplantation.Most of urological complications require surgical interventions.The long-term graft survival is not affected by a correctly treated urological complication.