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目的 有效地减少或避免同种异体肾移植术后移植肾输尿管膀胱吻合口瘘 ,延长移植肾的存活期。 方法 从病因、诊断和处理方面回顾性分析 30例肾移植患者术后移植肾输尿管膀胱吻合口瘘的临床资料。 结果 4例采用保守治疗 ,2例做单纯瘘口修补。 11例切除血供差、水肿严重的移植肾输尿管远端 ,或调整移植肾的位置 ,做移植肾输尿管膀胱再吻合。 13例膀胱翻瓣后 ,用2 0～ 2 4Foley尿管连接供肾的肾盂和受者膀胱瓣 ,其中 9例无法实现残留的移植肾输尿管与膀胱瓣无张力的间断缝合 ,只能待移植肾肾盂或上段输尿管沿Foley尿管爬行 ,形成隧道。受者 1年存活率96 7% (2 9/ 30 ) ,移植肾 1年存活率为 86 7% (2 6 / 30 )。 结论 肾移植的任何步骤处理不当都可以引起移植肾输尿管膀胱吻合口瘘 ;术中应根据输尿管血液供应 ,水肿情况 ,瘘口大小和输尿管的长度来选择不同的术式 ,以确保无张力的可靠吻合。
Objective To effectively reduce or avoid transplanted renal ureter anastomotic fistula after allo-renal transplantation and prolong the survival of transplanted kidneys. Methods From the etiology, diagnosis and treatment, the clinical data of 30 patients with renal transplantation of ureteric anastomotic leakage after renal transplantation were retrospectively analyzed. Results of 4 cases of conservative treatment, 2 cases of simple repair of fistula. 11 cases of poor removal of blood supply, severe edema graft distal ureter, or adjust the location of the kidney graft, kidney ureter and bladder re-stapling. 13 cases of bladder flap, with 20 ~ 24 Foley catheter for renal pelvis and recipient bladder flap, of which 9 cases can not be achieved residual graft ureter and bladder flap without tension intermittent suture, only to be transplanted kidney The renal pelvis or upper ureter crawled along the Foley catheter to form a tunnel. The 1-year survival rate of recipients was 96 7% (29/30), and the one-year survival rate of transplant recipients was 86 7% (26/30). Conclusion Any procedure of renal transplantation can lead to transposition of ureteric anastomotic fistula due to improper handling of the renal transplantation. Different types of surgical procedures should be chosen according to ureteral blood supply, edema, fistula size and ureteral length to ensure no tension and reliability Anastomosis.