支架管外引流与双J管内引流在小儿离断式肾盂成形术中的应用比较

目的 比较小儿离断式肾盂成形术后留置双J管内引流与肾造瘘支架管外引流的临床疗效及诊治经验.方法 2007年1月至2012年12月,我们收治77例因单侧肾盂输尿管连接部梗阻而行离断式肾盂成形术的患儿,将其分为留置双J管组（41例）和留置肾造瘘支架管组（36例）,比较两组手术时间、术中出血量、拔管和术后住院时间、住院费用、并发症的发生率及肾功能恢复情况.术后均经B超及ECT等进行随访.结果 两组在术后住院时间及并发症的发生率上比较,差异有统计学意义（P＜0.05）,双J管组术后平均住院时间为（7.63＋ 1.92）d,肾造瘘支架管组平均住院时间为（15.89＋ 3.41）d.术后并发症的发生率：双J管组（14.6％）明显低于肾造瘘支架管组（36.1％）.随着双J管留置时间的延长,并发症的发生率1～2个月组为17.6％,2～3个月组为26.3％,＞3个月组为100％.术后B超及ECT等随访,两组术前、术后肾功能相比（P＜0.01）均有明显恢复,恢复程度比较,差异无统计学意义（P＞0.05）.结论 小儿离断式肾盂成形术后置双J管内引流的疗效优于支架管外引流.

Comparison of the effect of external stent and double-J tube internal drainage in Anderson-Hynes Pyeloplasty

Objetive To compare the effect of urine drainage by double-J tube ureteral stent or by nephrostomy ureteral stent in Anderson-Hynes pyeloplasty and discuss the experience of diagnosis and treatment.Methods Retrospective analysis of 77 cases with ureteropelvic junction （UPJ） obstruction had undergone Anderson-Hynes pyeloplasty.We classified the children into the double-J tube stented group （46 cases） and the nephrostomy ureteral stented group （31 cases）.The two groups were compared operative time,blood loss,postoperative hospital stay,cost of hospitalization,the incidence of complications and renal functional recovery.Postoperative follow-up by the Ultrasound and ECT.Results The hospital stay and overall incidence of postoperative complications difference were statistically significant in the two groups （P ＜ 0.05）.The operative time and postoperative hospital stay of double-J tube group were shorter than nephrostomy ureteral stent group.The incidence of postoperative complications in double-J tube group（14.6％） was significantly lower than the nephrostomy ureteral stent group（36.1％）.With the extension of double-J tube indwelling time,the incidence of complications in group B（1 ～2 months） was 17.6％,and the C group（2 ～3 months） was 26.3％,the D group（＞ 3 months）100％ is gradually increased.Postoperative follow-up by the Ultrasound and ECT,The preoperative and postoperative renal function compared （P ＜0.01） were significantly restored,but the degree of recovery difference was not statistically significant （P ＞ 0.05）.Conclusion The use of double-J tube placed intraoperatively in Anderson-Hynes pyeloplasty can reduce the chance of complications and shorten the hospital stay,which was superior to ureteral stenting of extracorporal drainage.