肾移植术后尿瘘分类标准的建立  

Establishment of standards for classification of urinary fistula after kidney transplantation

作　　者：李黔生[1] 聂志林[1] 靳风烁[1] 霍文谦[1] 朱方强[1] 程晓斌[1] 黄坚[1] 马强[1] 袁刚[1] 

机构地区：[1]第三军医大学大坪医院泌尿外科,重庆400042

出　　处：《中华泌尿外科杂志》2009年第6期401-404,共4页Chinese Journal of Urology

摘　　要：目的建立肾移植术后尿瘘分类方法与标准。方法1993年12月至2009年2月行肾移植术1313例，发生尿瘘102例（7．8％）。根据尿道损伤分类原理，按照尿瘘病因、部位、数量及病变程度等分为单纯性和复杂性2类。结果102例中单纯性尿瘘81例，占79．4％。其中输尿管末端坏死76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20．6％。其中瘘口部位于肾盂2例、输尿管2例、输尿管膀胱吻合口11例、输尿管坏死段〉2cm6例。保守疗法治愈34例（33．3％），手术治愈68例（66．7％）。死亡3例，占2．9％，死亡原因为尿瘘导致重症肺部感染。结论建立肾移植术后尿瘘诊治“五步流程”制度，将其分为单纯性和复杂性两类，可使尿瘘诊断更加细致及规范化。有利于选择最佳治疗方案。Objective To establish the standards for classification of urinary fistula after kidney transplantation. Methods From December 1993 to February 2009, 1313 cases of renal transplantations were operated, out of which 102 cases of urinary fistulas occurred （7.8%）. Based on the princi ple of the urethral injury classification method, we divide urinary fistula into simple and complex classes by the cause, location, and the severity of the disease. Results There were 81 cases （79.4G） of simple urinary fistulas, of those 76 cases were ureteral end necrosis,4 cases were due to ureter bladder anastomosis suture, 1 case was anastomotie problem caused by wound infection. There were 21 cases（20.6%） of complex urinary fistulas, of these 2 cases had fistulas at renal pelvis, 11 cases at ure ter-bladder interface and 6 cases had ureteral necrosis longer than 2 cm. For the 81 cases urinary fistulas patients, 34 patients conservative treatments were cured and 47 patients need surgeries. For all complex urinary fistulas need surgeries： 11 cases had surgery once, 5 cases had 2 times, 3 cases had 3 times and 2 cases had 4 times. Among the 2 groups, three patients （2.9%） died of urinary fistulas which led to severe lung infection. Conclusions A ＂Five Steps Procedure＂ could be used for diagnosis and treatment of post renal transplantation fistula. The urinary fistulas are divided into simple and complex types after renal transplantation. This provides a guidance for the best choice of treatment.

关 键 词：肾移植 尿瘘 分类 

分 类 号：R686[医药卫生—骨科学]