肾移植后尿瘘分类标准的应用:68例分析  

Application of urinary fistula classification standard after renal transplantation: Analysis of 68 cases

作　　者：李黔生[1] 聂志林[1] 靳风烁[1] 张克勤[1] 朱方强[1] 霍文谦[1] 程晓斌[1] 黄坚[1] 马强[1] 袁刚[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》2009年第31期6133-6136,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：为了使肾移植后尿瘘诊断更加规范,根据肾移植后尿瘘诊断分类的标准,将解放军第三军医大学大坪医院野战外科研究所泌尿外科1993-12/2008-10肾移植1313例中术后发生尿瘘68例患者进行分类。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。68例肾移植后尿瘘中,单纯性尿瘘47例,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%。尿瘘瘘口部位: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。手术修补次数:1次11例,2次5例,3次3例,4次2例。死亡2例,占2.9%,死亡原因为尿瘘导致重症肺部感染。提示:将肾移植后尿瘘分为单纯性和复杂性尿瘘两大类的优点是,一是使尿瘘诊断更加细致及规范化;再是选择最佳的治疗方案,达到最好治疗效果。1313 patients who received renal transplantations at Department of Urology, Research Institute of Field Surgery, Daping Hospital, Third Military Medical University of Chinese PLA from December 1993 to October 2008 were selected in the experiment. Urinary fistula occurred in 68 patients of them after renal transplantation. In order to make diagnosis more standard, 68 patients was classified in accordance with diagnostic classification standards after renal transplantation. The 68 patients were divided into simple and complex urinary fistulas in accordance with lesion degree. They were divided into low, high and multiple fistulas in accordance with the position and etiology. 47 （69.1%） of 68 cases were simple urinary fistulas： 42 cases were because of terminal ureteral necrosis; 4 cases were because the anastomosis was mended unsuitably; 1 case was because of poor healing of anastomosis due to infections. 21 （30.9 %） cases were complex urinary fistulas. The position of orificium fistula： orificium fistula located at renal pelvis, ureter and anastomosis were 2, 2 and 11 cases, respectively. 6 cases had ureteral necrosis longer than 2 cm. The times of repair： 11 cases had 1 time, 5 cases had 3 times, 3 cases had 3 times and 2 cases had 4 times. 2 cases （2.9%） died because of severe pulmonary infection caused by urinary fistula. Result suggests that there are two advantages of dividing urinary fistula into the simple and complex types after renal transplantation： one is that the diagnosis of urinary fistula is more carefully and standardized, and the other is that doctors can make the best choice for treatment in order to get the best efficacy.

关 键 词：肾移植 尿瘘 分类 

分 类 号：R617[医药卫生—外科学]