肾移植术后不同部位尿瘘的治疗策略  

Strategy of differently located urinary fistulae after kidney transplantation

作　　者：霍文谦[1] 靳风烁[1] 聂志林[1] 张克勤[1] 朱方强[1] 李黔生[1] 

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

出　　处：《重庆医科大学学报》2009年第9期1196-1198,共3页Journal of Chongqing Medical University

摘　　要：目的:探讨肾移植术后不同部位尿瘘的最佳治疗方法。方法:将68例肾移植术后尿瘘患者分为低位瘘(包括吻合口瘘和膀胱瘘)和高位瘘(包括输尿管瘘、肾盂瘘)。尿瘘部位根据膀胱造影、磁共振水成像及手术探查结果确定。尿瘘诊断后先行保守治疗,即立即放置负压引流管引流伤口渗液,逆行插入双"J"导管及留置尿管。无效时立即手术修补尿瘘。比较不同部位尿瘘的治疗效果。结果:低位瘘26例(38.2%)中20例(76.9%)保守治疗成功,6例(23.1%)手术治疗,其中5例治愈,1例因急性排斥反应切除移植肾;高位瘘42例(61.8%)中8例(19.0%)保守治疗成功,34例(81.0%)手术治疗,其中29例治愈(包括8例再次手术),3例移植肾切除(2例修补失败,1例急性排斥反应),2例因肺部感染死亡。低位瘘保守治疗成功率明显高于高位瘘(P<0.01)。结论:肾移植术后尿瘘的定位诊断对选择治疗方法有重要意义。对于低位尿瘘可首选保守治疗,无效时再考虑手术治疗,而对于高位尿瘘应尽早开放手术治疗。Objective：We summarized the therapeutic results of 68 differently located urinary fistulae after kidney transplantation in order to approach optimal treatments for them. Methods： Between December 1994 and July 2008, fistulae were observed in 68 of 1263 patients （5.4%） after kidney transplantation,including 26 lower fistulae and 42 upper fistulae. The former included vesical fistulae and stoma fistulae,while the latter included ureter fistulae,pelvis fistulae.The location of fistulae was determined by cystography, magnetic resonance hydrography（MRH） or operation research. In both groups we first adopted conservative treatment which was placing a negative pressure drainage tube draining the wounds and placing a double-J catheter or a urinary canal in,however,if invalid,we resorted to surgical repair. Subsequently, therapeutic efficacies of differently located fistulae observed. Results： Twenty of 26 lower fistulae（76.9%） were cured successfully by conservative treatment For the remaining 6 cases（23.1%）,we had to turn to open surgery, among which 5 were cured and 1 underwent nephrectomy because of acute rejection. Only 8 of 42 upper fistula（19.0%）were cured by conservative treatment, but the other 34（81.0%）cases accepted open surgery among which 29 were cured, and 3 underwent nephrectomy owing to acute rejection （1 case）and failure of surgery（2 cases）, and 2 died of pulmonary infection. The achievement ratio of conservative treatment in lower fistulae was significantly higher than that of upper fistulae（76.9% vs. 19.0%,P〈0.01）. Conclusion： It is necessary to determine the location of urinary fistula after kidney transplantation. We can first adopt conservative treatment for lower fistulae, and only if invalid can we consider open surgery. For upper fistulae, it is wise to select open surgery.

关 键 词：尿瘘 治疗 肾移植 

分 类 号：R699[医药卫生—泌尿科学]