带蒂大网膜移植修补肾移植术后复杂性尿瘘  

Pedicled omentum grafts in the repair of complex urinary fistulas after renal transplantation

作　　者：陈锦[1] 李黔生[1] 靳风烁[1] 蒋小娟[1] 朱恋[1] 祝清清[1] 肖乾燕[1] 

机构地区：[1]解放军第三军医大学大坪医院野战外科研究所泌尿外科,重庆市400042

出　　处：《中国组织工程研究与临床康复》2007年第47期9588-9589,共2页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:肾移植术后尿瘘可导致移植肾切除,探讨带蒂大网膜移植修补肾移植术后复杂性尿瘘的应用价值。方法:选择1997-01/2006-12解放军第三军医大学大坪医院野战外科研究所收治的应用带蒂大网膜移植修补肾移植术后复杂性尿瘘患者21例,对治疗方案均知情同意。肾盂瘘切除瘘口后局部修补再用带蒂大网膜移植覆盖,输尿管瘘、输尿管膀胱吻合瘘或输尿管长段坏死者在行移植肾输尿管与自体输尿管对端吻合或与膀胱再植后用带蒂大网膜包绕于吻合口。术后进行随访。结果:①手术1次成功20例,成功率95.2%(20/21)。失败原因为伤口感染导致大网膜坏死而切除移植肾。②手术时间75～120min,平均95min。术中失血100～550mL,平均310mL;输血0～400mL。③住院时间25～57d。④随访6～12个月,尿瘘无复发,吻合口无狭窄及肾积水,肾功能正常。结论:利用大网膜的生物学特性,采用带蒂大网膜修补肾移植术后复杂性尿瘘具有取材方便、组织修复快、尿瘘复发率低的特点;同时可以减少局部感染及纤维化的机会,梗阻并发症少,远期效果好。AIM：Urinary fistulas can result in grafting nephrectomy after renal transplantation. This article is aimed to investigate the applied value of the pedicled omentum grafts for the repair of complex urinary fistulas after renal transplantation. METHODS： Totally 21 cases of complex urinary fistulas after renal transplantation with pedicled omentum grafts at Research Institute of Surgery, Daping Hospital, Third Military Medical University of Chinese PLA from January 1997 to December 2006. All patients signed the informed consent. For pelvic fistulas, pedicled omentum grafts were used to cover the raw surface after orificium fistulas were resected and repaired. For urinary fistulas taking place because of other causes, pedicled omentum grafts were used to cover and surround stoma after sutur/ng the ureter of transplantation kidney with autoallergic ureter end to-end anastomosis or reimplant the ureter of transplantation kidney to bladder. Follow-up was performed after operation. RESULTS： ①20 of 21 cases were successful by one operation （95.2%）. Only 1 case failed （4.8%） because of wound infection, resulting in the necrosis of omentum and the kidney were resected. ②The operation time were 75 to 120 minutes, averagely 95 minutes. Blood loss were 100 to 550 mL, averagely 310 mL and blood transfusion were 0 to 400 mL. ③Length of stay were 25 to 57 days. Within the 6 to 12 months follow-up, the urinary fistulas did not relapse, no stegnosis or hydronephrosis, and renal function were normal. CONCLUSION： With biological characteristics of omentum, applying pedicled omentum grafts to repair complex urinary fistulas after renal transplantation has advantages as followings, convenient to draw material, recovering tissue quickly and low recurrence rate. Meanwhile, chance of infection, fibrosis and obstructive complication is reduced, and long-term effect is good.

关 键 词：网膜移植 尿瘘 肾移植 组织移植 

分 类 号：R655.4[医药卫生—外科学]