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

发布时间：2018-06-07 23:51

本文选题：肾移植 + 尿瘘　；参考：《中南大学学报(医学版)》2017年01期

【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(P0.05)、移植肾功能延迟恢复(P0.01)、膀胱痉挛(P0.05)及供肾动脉为多支(P0.01)。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(P0.05)、移植肾功能延迟恢复(P0.05)、膀胱痉挛(P0.05)、尿瘘(P0.01)及供肾动脉为多支(P0.01)。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。
[Abstract]:Objective: To evaluate the incidence of ureteral fistula and stenosis after renal transplantation, to find the risk factors and to use bladder ureteroplasty for the treatment of renal transplant ureteral complications. Methods: a retrospective analysis of 270 cases of renal transplantation from January 2010 to January 2015 in the organ transplant of Xiangya Hospital of Central South University. The patients' clinical data and risk factors were treated by bladder flap ureteroplasty, ureteral bladder replantation and endoscopic placement of DJ tubes, and the surgical methods and effectiveness were analyzed. Results: the incidence of ureteral ureteral fistula after renal transplantation was 3.3%, the risk factor was the donor age (P0.05), and the delayed graft function was delayed. Recovery (P0.01), bladder spasm (P0.05) and donor renal artery were multiple (P0.01). 4 cases were cured after conservative treatment and 5 cases were cured by bladder ureteroplasty. The incidence of ureteral stenosis was 4.4%. The risk factors were donor age (P0.05), renal allograft Chi Huifu (P0.05), bladder spasm (P0.05), urinary fistula (P0.01) and donor renal artery. Multiple (P0.01).4 routine endoscopic treatment, of which 2 cases underwent percutaneous nephrostomy after percutaneous nephrostomy to place DJ tube anterograde, 2 cases of ureteroscopy retrograde insertion of the DJ tube, all improved.8 routine operation, of which 6 cases of bladder muscle flap ureteroplasty, 2 cases of transplanted renal ureteral replanting, all cured after the operation. Conclusion: renal and ureteral complications are mainly included. Urinary fistula and ureteral stenosis have a lower overall incidence, but have a greater impact on renal transplantation and quality of life. The risk factors for ureteral complications include donor age, delayed graft function recovery, bladder spasm and donor kidney. Ureteral fistula is a risk factor for ureteral duct stricture. Bladder ureteral formation It is an effective method for the treatment of ureteral fistula and ureteral stricture.
【作者单位】：中南大学湘雅医院器官移植中心;中南大学湘雅医院泌尿外科;
【分类号】：R699

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