Goldstein I, Cho S I, Olsson C A
J Urol. 1981 Aug;126(2):159-63. doi: 10.1016/s0022-5347(17)54426-2.
The use of temporary diverting nephrostomy drainage in the management of immunosuppressed renal transplant patients with supravesical urinary extravasation, fistulas or ureteral obstruction is reviewed. In a literature survey covering an 11-year interval and 4,307 transplants there were 204 cases (4.7 per cent) of ureteral extravasation or fistula and 113 cases (2.6 per cent) of ureteral obstruction. Attempts at urologic repair in these 317 cases resulted in 30.9 per cent failure rate (98 cases), of which 86.7 per cent (85 cases) occurred in patients without nephrostomy compared to 13.3 per cent (13 cases) in patients with nephrostomy. In our 255 consecutive renal transplant patients there were 7 (2.7 per cent) with ureteral extravasation or fistula and 14 (5.5 per cent) with ureteral obstruction. Temporary nephrostomy was done in all 21 patients to protect the urologic repair and, when necessary, to control sepsis and allow for patient stabilization before delayed urinary tract reconstruction. In our series there was no mortality and only 1 renal unit (4.7 per cent) was lost as a consequence of urologic complications. The use of nephrostomy in transplant patients with ureteral extravasation, fistulas or ureteral obstruction is encouraged strongly to optimize patient and renal unit survival.
回顾性分析了临时转流性肾造瘘引流术在免疫抑制的肾移植患者中用于处理膀胱上尿路外渗、瘘管或输尿管梗阻的应用情况。在一项涵盖11年期间4307例肾移植手术的文献调查中，有204例（4.7%）发生输尿管外渗或瘘管，113例（2.6%）出现输尿管梗阻。在这317例患者中尝试进行泌尿外科修复，失败率为30.9%（98例），其中86.7%（85例）发生在未行肾造瘘的患者中，而行肾造瘘患者的失败率为13.3%（13例）。在我们连续的255例肾移植患者中，有7例（2.7%）发生输尿管外渗或瘘管，14例（5.5%）出现输尿管梗阻。对所有21例患者均进行了临时肾造瘘，以保护泌尿外科修复，必要时控制感染，并在延迟尿路重建前使患者病情稳定。在我们的系列研究中，无死亡病例，仅1个肾单位（4.7%）因泌尿外科并发症而丧失。强烈鼓励在输尿管外渗、瘘管或输尿管梗阻的移植患者中使用肾造瘘术，以优化患者和肾单位的生存率。
