Moray G, Yagmurdur M C, Sevmis S, Ayvaz I, Haberal M
Department of General Surgery, Division of Transplantation, Başkent University Faculty of Medicine, Fevzi Cakmak Caddesi, 10.sokak No. 45, 06 490 Ankara, Turkey.
Transplant Proc. 2005 Mar;37(2):1052-3. doi: 10.1016/j.transproceed.2005.01.083.
It is still not clear whether double-J stents (DJS) are of benefit. We sought to determine whether routine prophylactic use of DJS reduced postoperative complications after renal transplantation. We prospectively evaluated 42 living donor renal transplantations performed between September 2001 and September 2003. The patients were randomly assigned to one of two groups: 21 operations (group 1), included a DJS placed during Lich-Gregoir ureterocystotomy and 21 cases (group 2), a Lich-Gregoir ureterostomy without DJS insertion. Among group 1, the DJS were removed within the first month after transplantation. One patient in group 1 (5%) developed a urinary leakage. In group 2, there was one case of delayed graft function (5%) and one patient developed a hematoma (5%) at the operative site. The group rates for urinary tract infection were not significantly different (P > .05). In the early postoperative period, a renal biopsy was performed if a patient's creatinine level was elevated or remained elevated during 3 days after transplantation. Four patients in group 1 and 10 patients in group 2 required a renal biopsy (P = .04). All four of the group 1 biopsies and three of the group 2 specimens revealed acute rejection. The other seven group 2 biopsies showed tubuloepithelial injury. We suggest that ureteral stasis may cause tubuloepithelial injury and slow down the decrease in creatinine levels. In our model, the DJS did not increase urinary tract infections but provided a smooth decline in creatinine levels, which may reduce the question of acute rejection.
双J管（DJS）是否有益仍不明确。我们试图确定常规预防性使用DJS是否能减少肾移植术后并发症。我们前瞻性评估了2001年9月至2003年9月期间进行的42例活体供肾肾移植手术。患者被随机分为两组：21例手术（第1组），包括在Lich-Gregoir输尿管膀胱吻合术中放置DJS；21例（第2组），进行Lich-Gregoir输尿管造口术但未插入DJS。在第1组中，DJS在移植后的第一个月内取出。第1组中有1例患者（5%）发生尿漏。在第2组中，有1例发生移植肾功能延迟恢复（5%），1例患者在手术部位出现血肿（5%）。两组的尿路感染发生率无显著差异（P>0.05）。术后早期，如果患者的肌酐水平在移植后3天内升高或持续升高，则进行肾活检。第1组有4例患者和第2组有10例患者需要进行肾活检（P = 0.04）。第1组的所有4例活检以及第2组的3例标本显示急性排斥反应。第2组的其他7例活检显示肾小管上皮损伤。我们认为输尿管梗阻可能导致肾小管上皮损伤，并减缓肌酐水平的下降。在我们的模型中，DJS并未增加尿路感染，但使肌酐水平平稳下降，这可能减少急性排斥反应的问题。
