CAJ | 학술논문

对解放军成都军区总医院1998-12/2008-12肾移植后出现尿瘘23例患者的病因、诊断及治疗结果进行回顾性分析.23例中行1次肾移植21例,2次2例;吻合方式9例采用肾动、静脉与髂外动、静脉端侧吻合,14例采用肾动脉与髂内动脉,肾静脉与髂外静脉吻合.23例患者随访6～12个月,17例为移植后3～7 d发生尿瘘,6例为移植后7～10 d发生;17例为吻合口瘘,4例为输尿管远端坏死,2例为肾盂瘘.保守治疗11例,手术治疗12例.手术患者中,9例采用常规手术方法的患者有1例再次出现尿瘘,经二次手术后治愈;3例采用带蒂大网膜修补法,尿瘘无复发,移植肾B超检查无积水,患者肾功能正常.手术一次成功率92%(11/12),其中采用带蒂大网膜修补法成功率为100%.提示尿瘘最重要的是预防,从取肾、修肾到手术中都要注意保护输尿管,同时注意输尿管与膀胱的吻合技巧,避免因手术原因导致吻合口瘘,这样才能减少尿瘘的发生,同时一旦出现尿瘘后应根据不同情况及时处理,这样才能最大程度减少尿瘘对移植肾功能的损害.
대해방군성도군구총의원1998-12/2008-12신이식후출현뇨루23례환자적병인、진단급치료결과진행회고성분석.23례중행1차신이식21례,2차2례;문합방식9례채용신동、정맥여가외동、정맥단측문합,14례채용신동맥여가내동맥,신정맥여가외정맥문합.23례환자수방6～12개월,17례위이식후3～7 d발생뇨루,6례위이식후7～10 d발생;17례위문합구루,4례위수뇨관원단배사,2례위신우루.보수치료11례,수술치료12례.수술환자중,9례채용상규수술방법적환자유1례재차출현뇨루,경이차수술후치유;3례채용대체대망막수보법,뇨루무복발,이식신B초검사무적수,환자신공능정상.수술일차성공솔92%(11/12),기중채용대체대망막수보법성공솔위100%.제시뇨루최중요적시예방,종취신、수신도수술중도요주의보호수뇨관,동시주의수뇨관여방광적문합기교,피면인수술원인도치문합구루,저양재능감소뇨루적발생,동시일단출현뇨루후응근거불동정황급시처리,저양재능최대정도감소뇨루대이식신공능적손해.
The etiological factor, diagnosis, as well as therapeutic results of 23 cases with urinary fistula following renal transplantation, at the Chengdu Military General Hospital, from December 1998 to December 2008, were analyzed retrospectively, including 21 cases with a renal transplantation, 2 cases with retransplantation; 9 cases adopt renal artery, renal veins to external lilac artery, external lilac vein anastomosis, 14 cases with renal artery to internal lilac artery, renal veins to external lilac vein anastomosis. 23 cases were followed-up for 6-12 months, 17 cases suffered urinary fistula at days 3-7 after transplantation, 6 cases occurred at days 7-10; there were 17 stoma fistulae, 4 distal end necrosis of ureter, 2 ureteral fistulae. 11 cases were received conservative treatment, and 12 cases with operation. Among the surgery patients, 9 cases received conventional operation and 1 of them returned with urinary fistula and then was cured by second operations; 3 patients received pedicled omentum transplantation and no recurrence or hydronephrosis happened with normal renal function. The one-time success rate was 92% (11/12), of which the repair success rate using pedicled omental was 100%. The results demonstrated that prevention plays an important role in urinary fistula, and ureter should be protected during the surgery. Meanwhile, stoma fistula should be avoided. Promptly treatment following urinary fistula is also necessary to reduce the damage of urinary fistula to the renal function.