French C G, Acott P D, Crocker J F, Bitter-Suermann H, Lawen J G
Department of Urology and Pediatrics, IWK-Grace Health Center, Dalhousie University, Halifax, Nova Scotia, Canada.
Pediatr Transplant. 2001 Feb;5(1):21-6. doi: 10.1034/j.1399-3046.2001.00024.x.
The use of ureteric double-J stents and the Lich-Gregoir (extravesical) technique of ureteroneocystotomy have both been shown to decrease the rate of urologic complications in adult kidney transplantation (Tx). There are, however, few studies of the systematic use of stents in pediatric renal Tx. Between 1991 and 1997, 32 consecutive pediatric renal transplant recipients routinely received a 6F-12 cm indwelling double-J stent and were studied prospectively. These patients were compared with 32 consecutive pediatric recipients in whom a stent was not used. The latter were transplanted between 1987 and 1991 and formed the control group. All patients had a Lich-Gregoir ureteroneocystotomy. Stents were removed under general-anesthetic cystoscopy 2 3 weeks after Tx. Immunosuppression for stented patients was polyclonal antibody induction, delayed (7-10 days) cyclosporin A, azathioprine, and prednisone. The control group received the same triple drug regimen but with no induction in 29 of the 32 patients. All patients were followed-up with at least one ultrasound evaluation in the first month, and a renal scan and repeat ultrasound were performed if there was any rise in serum creatinine. In the stented group there were two patients with urinary leak and no obstructions. In the non-stented group there were no leaks and one obstruction. There was no graft loss owing to urologic complications in either group. There were three cases of stent expulsion (all in girls) and one case of stent migration in the posterior urethra (a boy). The 1-yr graft survival rate was 90.6% in the stented group and 65.6% in the non-stented group. The prophylactic use of an indwelling ureteral stent in pediatric renal Tx did not reduce the risk of urinary leakage or obstruction. Stent migration is a common phenomenon and, while not a serious complication, is traumatic to children. Furthermore, removal of an internalized double-J stent requires a general anesthetic. We recommend using a stent for selected patients only.
输尿管双J支架的使用以及Lich-Gregoir（膀胱外）输尿管膀胱吻合术均已被证明可降低成人肾移植中泌尿系统并发症的发生率。然而，关于在小儿肾移植中系统使用支架的研究却很少。在1991年至1997年期间，32例连续的小儿肾移植受者常规接受了一根6F-12厘米的留置双J支架，并进行了前瞻性研究。将这些患者与32例连续的未使用支架的小儿受者进行比较。后者于1987年至1991年期间接受移植，构成对照组。所有患者均接受了Lich-Gregoir输尿管膀胱吻合术。移植术后2至3周，在全身麻醉下通过膀胱镜取出支架。接受支架治疗的患者的免疫抑制方案为多克隆抗体诱导、延迟（7至10天）使用环孢素A、硫唑嘌呤和泼尼松。对照组接受相同的三联药物方案，但32例患者中有29例未进行诱导治疗。所有患者在第一个月至少接受一次超声评估，如果血清肌酐升高，则进行肾脏扫描和重复超声检查。在使用支架的组中，有2例患者出现尿漏，无梗阻病例。在未使用支架的组中，无尿漏病例，有1例梗阻病例。两组均未因泌尿系统并发症导致移植肾丢失。有3例支架排出（均为女孩）和1例支架迁移至后尿道（1名男孩）。使用支架的组1年移植肾存活率为90.6%，未使用支架的组为65.6%。在小儿肾移植中预防性使用留置输尿管支架并不能降低尿漏或梗阻的风险。支架迁移是一种常见现象，虽然不是严重并发症，但对儿童有创伤性。此外，取出内置的双J支架需要全身麻醉。我们建议仅对选定的患者使用支架。
