胃管作支撑引流管在小儿肾盂成形术中的应用

Using feeding tube as stent and drainage after pyeloplasty in children a report of 300 cases

目的 离断式肾盂成形术是治疗小儿肾盂输尿管连接处梗阻的最常用手术 ,但在术后尿液引流方式、吻合口是否需要支撑等问题上仍存在争议。我们回顾性总结 7年来采用胃管作支撑引流管行离断式肾盂成形术的 30 0余例患儿资料。方法 1994年 6月至 2 0 0 1年 9月 ,采用胃管作支撑引流管行离断式肾盂成形术 30 0例 ,共 30 4侧 ,均为肾盂输尿管连接处梗阻患儿 ,其中双侧 4例。19例患儿 (19侧 )另放置了肾造瘘管。术后随访B超、IVU、利尿性肾图、尿常规等 ,随访期 6个月至 7年。结果 3例患儿 (0 .98% )出现肾盂输尿管连接处再狭窄 ,2例术后出现尿路结石。其余患儿随访显示吻合口通畅 ,肾功能得到保存或提高 ,未见尿路感染。结论 胃管作为支撑引流管应用于肾盂成形术是可靠的 ,具有反应小 ,引流完全 ,术后处理简便 ,可行冲洗、造影、测压检查等诸多优点。

Objective To sum up the experiences of using feeding tube as a stent and drainage after pyeloplasty in patients with ureteropelvic junction obstruction (UPJO). Methods From June 1994 to Sept. 2001, 300 cases (bilateral in 4 cases) with UPJO who underwent dismembered pyeloplasty were reviewed retrospectively. A feeding tube was inserted in all patients as a stent and drainage. Of which, a combined nephrostomy tube was placed in 19 cases. Ultrasonography, intravenous urogram (IVU), diuretic renogram and urinal routine were followed at 3 months and 6 months postoperatively. The follow up period ranged from 6 months to 7 years. Results The outcome revealed a wide patent anastomosis with renal function preserved or improved, except 3 patients had postoperative obstruction and 2 urinary lithiasis formation. Conclusions Using feeding tube as stent and drainage after dismembered pyeloplasty is reliable and effective without any adverse reaction. It is also an easy way to flashing, radiographic study and pressure measurement before tubing removal.