顺行“挂钩”法置入双J管在腹腔镜肾盂成形术中的应用

The "Hook Method" Applied for Intracorporeal Antegrade Double-J Stenting During Laparoscopic Pyeloplasty

目的探讨以"挂钩"的方式顺行置入双J管在腹腔镜肾盂成形术中的应用。方法 2014年10月~2016年5月对28例肾盂输尿管连接部梗阻行腹腔镜肾盂成形术,在完成肾盂输尿管连接部后壁的缝合后,双J管以"挂钩"的方式顺行置入输尿管内,双J管远端进入膀胱内,撤出导丝及推管,腹腔镜弯钳将双J管近端放置肾盂内,完成肾盂输尿管连接部的前壁缝合。结果 28例双J管均以顺行方式顺利置入,围手术期无并发症发生。镜下置管时间2 min 30 s^4 min 45 s,平均3 min 5 s。术后4~6周拔除双J管,复查泌尿系超声或静脉肾盂造影,肾积水较术前减轻(术前中度17例,重度11例;术后中度9例,轻度13例,无肾积水6例)。结论顺行"挂钩"法置入双J管安全、操作简便,利用双J管自身的优势,不需要额外辅助器械,为腹腔镜肾盂成形手术中置入双J管提供一种新的思路。

bmObjective To evaluate a technique of ＂ hook method＂ antegrade placement of double-J catheter in laparoscopic pyeloplasty. Methods Clinical data of 28 patients with ureteropelvic junction obstruction（ UPJO） who underwent laparoscopic pyeloplasty from October 2014 to May 2016 were retrospectively analyzed. After the accomplishment of posterior suture of dismembered pyeloplasty,a double-J stent was antegraded inserted through the ureteral with ＂ hook method＂,and the lower end of the stent was placed in the bladder. Then the guide wire and push tube were removed and the upper end of the stent was positioned in the renal pelvis. The anastomosis of the anterior suture was completed. Results The stent was correctly placed in all these patients without any stent-related complications. The mean time of insertion was 3 minutes and 5 seconds（ range,2 minutes and 30 seconds-4minutes and 45 seconds）. The double-J stent was removed at 4-6 weeks. Satisfactory drainage with decreased hydronephrosis was documented in all the cases with ultrasonography or intravenous urography postoperatively. Conclusions The ＂ hook method ＂ applied for intracorporeal antegrade double-J stenting during laparoscopic pyeloplasty is a safe and simple technique. There is no need of additional auxiliary equipments. It is a noval opetion for double-J stenting in laparoscopic pyeloplasty.