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目的:总结肾移植术后漏尿的病因、诊断、治疗与预防。方法:回顾分析145例肾移植术后4例发生漏尿病人的临床资料。结果:发生率2.76%。1例术后早期漏尿保守治疗3周痊愈;1例输尿管多处坏死两次修补失败,保守治疗5周愈合;1例输尿管膀胱吻合口坏死及1例肾盂积水破裂一次修补成功。结论:外科技术失误是漏尿的主要原因,另外还与急性排异等有关。漏尿部位大多位于输尿管下端,也可发生于全程输尿管和肾盂。表现为尿外漏、肾周积液、少尿、腹腔积液。漏尿时间多发生在术后3周左右,急性排异引起者发生于排异控制后的多尿期,表现为尽量骤减。保守治疗适用于早期尿外漏及肾局积液者,3周以上不愈或漏尿有增多趋势者应手术探查修补。腹腔内大量积尿者应急诊手术。该并发症大多数是可以预防的。
Objective: To summarize the etiology, diagnosis, treatment and prevention of urine leakage after renal transplantation. Methods: A retrospective analysis of 145 cases of kidney transplantation after the occurrence of leakage in patients with clinical data. Results: The incidence of 2.76%. One case was treated with conservative treatment of early leakage of urine for 3 weeks. One case of ureteral multiple necrosis failed to repair twice and healed conservatively for 5 weeks. One case of ureteral anastomosis necrosis and one case of hydronephrosis ruptured successfully. Conclusion: Surgery technical errors is the main reason for leakage of urine, in addition to acute rejection and so on. Urine leakage sites are mostly located in the lower ureter, ureter and renal pelvis can also occur in the entire process. The performance of urine leakage, perirephric fluid, oliguria, ascites. Urine leakage occurred more than 3 weeks after surgery, caused by acute rejection occurred in the control of polyuria after rejection, showed as much as possible. Conservative treatment for early urinary leakage and renal effusion who, more than 3 weeks or more leakage of urine leakage trend should be surgical exploration and repair. Abdominal cavity large amount of urine emergency surgery. Most of the complications are preventable.