亲属肾及尸肾移植后尿漏发生率的比较分析  

Urinary fistula after living-related or deceased-donor kidney transplantation and its prevention

作　　者：袁渊[1] 曾甫清[2] 李恒[2] 

机构地区：[1]湖北医药学院附属太和医院泌尿外科,湖北省十堰市442000 [2]华中科技大学同济医学院附属协和医院泌尿外科

出　　处：《临床外科杂志》2010年第11期744-746,共3页Journal of Clinical Surgery

摘　　要：目的 探讨亲属肾及尸肾移植后尿漏发生的原因差异及预防策略,以降低尿漏发病率及死亡率.方法 选取2005年1月至2009年12月华中科技大学同济医学院附属协和医院行亲属肾移植及尸肾移植患者340例,分为尸肾移植组及亲属肾移植组,根据其发病原因、术前检查、配型、移植方式、抗排斥反应药物应用、并发症等差异,分析尿漏的原因及其结果.结果 五年来共行尸肾移植176例,亲属肾移植164例,确诊尿漏15例,其中尸肾移植后尿漏12例,发生率6.2%,亲属肾移植后尿漏3例,发生率1.8%,行个体化治疗后尸肾移植恢复功能11例,治愈率91.7%,尸肾移植后死亡1例,尸肾尿漏死亡率8.3%.亲属肾移植3例均恢复,治愈率100%.两组尿漏发生率比较,P〈0.05,差异有统计学意义.结论 尸肾发生尿漏原因主要有排斥反应、激素剂量过大、抗排斥反应药物中毒、取肾修肾损伤、热冷缺血时间较长、配型较差、术后并发症较多等.亲属肾移植尿漏主要原因在于手术方式及吻合技术,术后恢复处理上导致尿漏.预防在于术前明确肾脏血供,手术方式选择及注意手术技巧,加强抗排斥反应,抗反流乳头吻合及常规内置D-J管,加强术后规范治疗可减少其发生.亲属肾移植较尸肾移植尿漏发生率低,愈后好.Objective To examine the causes and prevention strategies of urinary fistula after living - related or deceased - donor kidney transplantation in order to decrease the occurrence of urinary fistula. Methods A total of 340 patients who underwent living - related or deceased - donor kidney transplantation within the past 5 years in our institute were enrolled and divided into living - related group and deceased - donor group. The causes of urinary fistula were analyzed according to its etiology,preopera- tive examination, matching, surgical method, application of anti - rejection drugs and complications by using X2 test. Results Deceased - donor kidney transplantation was performed in 176 cases and living - related kidney transplantation in 164 cases in the past 5 years. Urinary fistula was diagnosed in 12 cases in the deceased -donor group, accounting for 6.2%, and in 3 cases in the living - related group, accounting for 1.8%. The function of 11 kidney transplants of the urinary fistula patients recovered after individual treatments and one patient died in the deceased - donor group with the cure rate reaching 91.7%. The urinary fistula patients in the living - related group were all cured. The X2 test showed that the incidence of u- rinary fistula in the living - related group was significantly lower than that in the deceased - donor group（ P 〈 0.05）. Conclusion Urinary fistula is a frequent complication after renal transplantation. The incidence of urinary fistula after the living - related kidney transplantation is relatively low with good prognosis

关 键 词：肾移植 尿漏 预防 

分 类 号：R692[医药卫生—泌尿科学]