同一机构9年间1203例肾移植后尿瘘处理27例

目的:尿瘘作为肾移植后早期最常见的外科并发症发生率可高达3%～10%,处理不当容易致移植肾丢失.文章回顾性分析肾移植后并发球瘘临床资料,结合文献总结其处理经验.方法:选择解放军广州军区广州总医院2000-12/2009-03肾移植1 203例中发生尿瘘忠者27例,接受尸体供肾26例,活体供肾1例,男16例,女11例,平均年龄43岁.所有患者确定为尿瘘后先采取留置18Fr双腔气囊导尿管治疗,如果效果不好可采用手术探查.17例采用保守治疗,其中12例单纯伤口引流+留置膀胱18Fr导尿管双向引流,5例经膀胱镜逆行置入输尿管支架+留置膀胱18Fr导球管;10例进行开放手术探查,其中5例行移植肾输尿管与膀胱重新吻合术+置入输尿管支架,5例开放手术移植肾输尿管与自体输尿管端端吻合+置入输尿管支架,开放于术中有6例加用带蒂大网膜包绕于吻合口.结果:移植后因再次尿瘘而行手术损伤肾静脉切除移植肾1例,26例尿瘘治愈,随访3个月～7年,无再发尿瘘、吻合口狭窄、移植肾无积水及尿路感染,肾功能正常.结论:对丁肾移植后尿瘘应早诊断、早治疗,可先采取保守治疗,大多数忠者可以治愈,无效后及时采取手术干预,对于复杂性的尿瘘于吻合口处可采用带蒂大网膜包绕提高手术成功率.

Processing of urinary fistulas in 27 out of 1203 patients after renal transplantation in one hospital during 9 years

OBJECTIVE:Complication incidence of urinary fistula which frequently occurs following renal transplantation is 3%-10%.Thus,poor processing may cause loss of transplanted kidney.This study was designed to retrospectively analyze urinary fistula following renal transplantation and to summarize the processing experience.METHODS:A total of 27 out of 1 203 patients with urinary fistula following renal transplantation(16 males and female 11 and mean age of 43 years) were collected from Guangzhou General Hospital ...