中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (5): 773-776.doi: 10.3969/j.issn.1673-8225.2010.05.004

• 肾移植 kidney transplantation • 上一篇    下一篇

同种异体肾移植后95例尿瘘患者定性、定量、定位资料的回顾性分析

王显丁，解志远，卢一平，王  莉，林  涛，何  凡   

  1. 四川大学华西医院泌尿外科，四川省成都市 610041
  • 出版日期:2010-01-29 发布日期:2010-01-29
  • 通讯作者: 卢一平，教授，四川大学华西医院泌尿外科，四川省成都市 610041 yipinglu@163.com
  • 作者简介:王显丁☆，男， 1982年生，四川省资阳市人，汉族，四川大学华西医院在读博士，主要从事泌尿外科学研究。

Retrospective analysis of diagnosis and treatment of urinary fistula following renal transplantation in 95 cases

Wang Xian-ding, Xie Zhi-yuan, Lu Yi-ping, Wang Li, Lin Tao, He Fan   

  1. Department of Urinary Surgery, West China Hospital, Sichuan University, Chengdu  610041, Sichuan Province, China
  • Online:2010-01-29 Published:2010-01-29
  • Contact: Lu Yi-ping, Professor, Department of Urinary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China yipinglu@163.com
  • About author:Wang Xian-ding☆, Studying for doctorate, Department of Urinary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

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摘要：

背景：肾移植后尿瘘发生率较高，不仅影响患者伤口愈合，还可能引起局部及全身感染，严重者导致移植肾丢失甚至威胁患者生命。因此建立尿瘘诊治的规范化标准具有较好的临床应用意义。
目的：回顾性分析肾移植后95例发生尿瘘患者诊治情况。
方法：95例患者中男59例，女36例；年龄19~61岁，尿瘘发生于移植后1~40 d；单纯性尿瘘74例，复杂性尿瘘21例。根据临床经验和诊治常规，参照由第三军医大学大坪医院李黔生等报告的肾移植后尿瘘的定性、定位、定量分类诊断，保守治疗与手术治疗的“五步诊治流程”进行诊断及治疗。
结果与结论：56例采用保守治疗，治愈45例；50例采用手术治疗(含11例经保守治疗无效者)，治愈45例，其余5例中2例因伴发严重急性排斥反应，移植肾破裂出血而切除移植肾，3例死于重症肺部感染。90例中获长期门诊或信访随访者71例，随访时间2~11年，失访19例。单纯性尿瘘中56例获得随访，其中41例移植肾功能维持正常，10例诊断为慢性移植肾肾病，4例移植肾失功恢复血液透析,1例因肺癌死亡。复杂性尿瘘中15例获得随访，8例移植肾功能正常，4例诊断为慢性移植肾肾病，3例移植肾失功恢复血液透析。证实采用李黔生提出的“五步诊治流程”可有效规范肾移植后尿瘘患者诊治流程，取得良好临床疗效。

关键词: 肾移植, 尿瘘, 诊断, 保守治疗, 手术治疗

Abstract:

BACKGROUND: The high incidence of urinary fistula following renal transplantation not only influence on wound healing, but also result in local or systemic infection, even renal allograft loss or death. Therefore, it is necessary to establish a standard for diagnosing and treating of urinary fistula.
OBJECTIVE: To retrospectively analyze the diagnosis and treatment of urinary fistula following renal transplantation in 95 cases.
METHODS: In 95 cases, there were 59 males and 36 females, aged from 19 to 61 years, urinary fistula occurred at days 1-40 after renal transplantation, including 74 simple fistulas and 21 complex fistulas. Besides of our clinical experiences and routine methods, the “five-step procedure protocol” for diagnosis and treatment of urinary fistula reported by Li Qian-sheng was also referred.
RESULTS AND CONCLUSION: Totally 56 cases were managed by conservative treatment, 45 of whom were cured. 50 cases (including 11 cases those failed to cure by conservative treatment) were managed by surgical treatment, 45 of whom were cured. Of the remaining 5 cases, 2 grafts were removed because of graft rupture and massive hemorrhage caused by uncontrolled acute rejection, and 3 recipients died of severe pneumonia shortly after transplantation. 71 of the 90 cases were received long-term follow up, ranging 2 to 11 years. Of the simple urinary fistula cases, 56 were on regular follow up; 41 kept a normal graft function, 10 were diagnosed of chronic allograft nephropathy, 4 returned to hemodialysis and 1 died of lung cancer. Of the complicated ones, 15 were on regular follow up. 8 kept a normal graft function, 4 were diagnosed of chronic allograft nephropathy, and 3 returned to hemodialysis. The design of “five-step procedure protocol” makes urinary fistula diagnosis and treatment more ordered and standard, which can obtain excellent therapeutic efficiency.

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