末端带牵引线的输尿管支架管在肾移植中的应用价值

Application of tethered ureteral stent in renal transplantation

目的探讨自制末端带丝线输尿管支架管(双J管)在肾移植手术中的应用价值。方法 110例同种异体肾移植患者,完成动静脉吻合行膀胱输尿管吻合前,将国产双J管从移植肾输尿管断端置入肾盂,然后将1根1-0丝线缝合固定在双J管下端,留置单根线尾。线尾长度:男性25～30 cm,女性10～15 cm。按顺序、等长(1 cm)反折数次,用长镊将双J管远端连同反折好的全部丝线一并通过膀胱壁上已切开的孔送入膀胱内。完成置管后,行输尿管-膀胱吻合。术后排尿时丝线随尿排出。若丝线排出体外过长,则剪去部分丝线,留至距尿道口2 cm,并予红霉素眼膏涂于尿道口,每日2次。拔管时,不用麻醉,不借助任何设备,徒手牵拉露出尿道外口的固定线即可顺利将双J管拔出。结果 110例患者中有108例于术后7～16 d见丝线尾排出尿道外口,其中106例患者于术后2～3周徒手牵拉尿道口丝线,顺利将双J管拔出,成功率为96.4%。未成功4例中,有2例患者体外丝线留置过短,线头缩回尿道内,经膀胱镜检、用异物钳将丝线钳夹,顺利拔除双J管;另2例患者的丝线在膀胱内缠绕打结,用异物钳将双J管及丝线钳夹,顺利拔出。拔管前后无患者发生泌尿系感染。8例(7.3%)男性患者诉轻度尿道异物感,拔除双J管后症状消失。结论双J管末端带丝线徒手拔管法简单易行,拔管无创伤、无痛苦,减少患者经济负担,有较高的临床实用价值。

Objective To explore the clinical value of tethered ureteral stent（double J tube） in renal transplantation.Methods A new method of tethered double J tube was applied in 110 allogeneic renal transplantation patients before bladder ureteral anastomosis that followed arteriovenous anastomosis.A tether（1-0 suture silk） was sewed to the distal end of the ureteral stent.The length of the tether in male was 25-30 cm and 10-15 cm in female.The free end of the tube was inserted into the renal pelvis through the ureteral cuff.The other end with tether sewed on it and flexed by 1cm was put into the bladder through the incision on it.Then the anastomosis of ureter and the bladder was performed.The tether was discharged by urination postoperatively.The tether was cut by 2 cm long out of the urinary meatus.Erythromycin ointment was swabbed on the urinary meatus twice a day to prevent retrograde infection.The tube was removed by freehand pulling the tether extracorporeally without anesthesia.Results The tethers of 108 cases were successfully discharged out of the urinary meatus 7-16 d after the surgery.The tubes in 106 cases were successfully removed with the success rate 96.4% in 2-3 weeks postoperatively.In 4 unsuccessful cases,2 cases failed due to the distal end of the tethers were cut too short and they drew back into anterior urethra which were finally grasped under cystoscopy in the anterior urethra and pulled out.The tethers in another 2 failed cases intertwined in the bladder.The tubes were removed by cystoscopy.Eighteen male cases（7.3%） complained mild discomfort in the urethra which disappeared after the removal of the tethered tube.No urinary infection occurred.Conclusions The method of freehand removal of the double J tube by pulling the tethered ureteral stent is simple and easy to operate.It is an atraumatic,painless and economical way with high clinical value.