膀胱肌瓣输尿管成型术治疗肾移植术后输尿管尿瘘及狭窄  

Treatment of ureteral fistula and stricture following renal transplantation with Boari flap

作　　者：金鹏[1] 谢晋良[1] 顿金庚[2] 丁翔[1] 周成[1] 朱向荣[1] 伍列林[1] 杨波[1] 张纲[1] JIN Peng XIE Jinliang DUN Jingeng DING Xiang ZHOU Cheng ZHU Xiangrong WU Lielin YANG Bo ZHANG Gang(Centre of Organ Transplantation Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China)

机构地区：[1]中南大学湘雅医院器官移植中心,长沙410008 [2]中南大学湘雅医院泌尿外科,长沙410008

出　　处：《中南大学学报（医学版）》2017年第1期78-82,共5页Journal of Central South University ：Medical Science

摘　　要：目的:评估肾移植术后移植肾输尿管发生尿瘘及狭窄的发生率,寻找危险因素,以及使用膀胱肌瓣输尿管成型术治疗移植肾输尿管并发症的效果。方法:回顾性分析中南大学湘雅医院器官移植中心2010年1月至2015年1月完成的270例肾移植受者的临床数据和危险因素。治疗方式包括膀胱肌瓣输尿管成型术、输尿管膀胱再植术及内镜下放置DJ管等,并对手术方式及有效性进行分析。结果:肾移植术后移植肾输尿管尿瘘发生率为3.3%,危险因素为供者高龄(P<0.05)、移植肾功能延迟恢复(P<0.01)、膀胱痉挛(P<0.05)及供肾动脉为多支(P<0.01)。其中4例行保守治疗后痊愈,5例行膀胱肌瓣输尿管成型术治愈。输尿管狭窄发生率为4.4%,危险因素为供者高龄(P<0.05)、移植肾功能延迟恢复(P<0.05)、膀胱痉挛(P<0.05)、尿瘘(P<0.01)及供肾动脉为多支(P<0.01)。4例行内镜下处理,其中2例行经皮肾镜穿刺造瘘后顺行放置DJ管,2例输尿管镜逆行置入DJ管,均好转。8例行手术治疗,其中6例行膀胱肌瓣输尿管成型术,2例行移植肾输尿管再植,术后均治愈。结论:移植肾输尿管并发症主要包括尿瘘和输尿管狭窄,总体发生率较低,但对移植肾功能和患者生活质量均造成较大影响。输尿管并发症的危险因素包括供者高龄、移植肾功能延迟恢复、膀胱痉挛及供肾为多支。输尿管尿瘘是输尿管狭窄的危险因素。膀胱肌瓣输尿管成型术是治疗移植肾输尿管尿瘘和输尿管狭窄的有效方法。Objective： To estimate the incidence rate of ureteral fistula and stricture after kidney transplantation, and to evaluate the effect of bladder flap （Boari flap） on ureteral complication of the transplanted kidney. Methods： The clinical data and risk factors from 270 recipients of renal transplantation, who came from the Centre of Organ Transplantation, Xiangya Hospital, Central South University from January 2010 to January 201 s, were retrospectively analyzed. The surgical management included Boari flap for ureteral reconstruction, neoureterocystostomy and endoscopic therapy with double-J （DJ） stent placement. Surgical proceeding and the effectiveness were evaluated. Results： The incidence rate of ureteral fistula following renal transplantation was 3.3%. The risk factors for ureteral fistula included elder donor age （P〈0.05）, delayed graft function （P〈0.01）, bladder spasm （P〈0.05）, and multiple renal arteries in allograft （P〈0.01）. Four cases were recovered after conservative treatment, and the other 5 cases were recovered after the treatment with Boari flap for ureteric reconstruction. The incidence rate of ureteral stricture was 4.4%. The risk factors for ureteral stricture included elder donor age （P〈0.05）, delayed graft function （P〈0.05）, cystospasm （P〈0.05）, ureteral fistula （P〈0.01） and multiple renal arteries in allograft （P〈0.01）. Four cases underwent endoscopic therapy, 2 of them carried out percutaneous nephrostomy followed by antegrade DJ stent placement and the other 2 patients by retrograde DJ stent placement under ureteroscopy. Eight patients underwent surgery, 6 of them was treated by Boari flap for ureteral reconstruction and 2 patients were treated by neoureterocystostomy. M1 the patients recovered after surgical management. Conclusion： The ureteral complications after renal transplantation include ureteral fistula and stricture. Although the total incidence is low, the complications can result in adverse effects to the graft

关 键 词：肾移植 尿瘘 输尿管狭窄 膀胱肌瓣 

分 类 号：R699[医药卫生—泌尿科学]