Das Jayanta Kumar, Rangad Gordon M
Department of General Surgery, Minimally Invasive Surgery Unit, Nazareth Hospital, Shillong, Meghalaya, India.
Urol Ann. 2020 Oct-Dec;12(4):309-313. doi: 10.4103/UA.UA_48_19. Epub 2020 Aug 10.
To summarize a new and easy technique of double-J stent (DJ stent) placement after retroperitoneal laparoscopic ureterolithotomy (RLU).
RLU for upper and upper half of mid ureteric stones was performed successfully in 172 patients during the 8-year period between March 2011 and February 2019. In all the cases, a ureteric DJ stent was successfully placed by this new technique. A small-bore antral puncture needle is inserted into the retroperitoneal space to push down a DJ stent with a guidewire into the lower ureter. The tip of the antral puncture needle is manipulated to bring it near the ureterotomy site for easy insertion of the stent. The whole stent is pushed down leaving only the upper end in the ureterotomy area. Then, the guidewire is removed and the upper end is pushed up slowly into the renal pelvis.
DJ stents were successfully inserted by this technique in all the 172 cases. In most cases, the stent could be placed in <3 min (range between 2 and 8 min). In two patients, the upper end failed to fully coil in the renal pelvis, but as the stent was passed beyond the ureterotomy site, it served its purpose of an internal drain. None of our cases had any urinary leak. Stents were removed cystoscopically after 6-12 weeks.
This technique provides an easy, fast, and safe antegrade method of inserting a DJ stent after RLU.
总结一种新型且简便的经后腹腔镜输尿管切开取石术（RLU）后置入双J管（DJ管）的技术。
在2011年3月至2019年2月的8年期间，172例患者成功接受了针对输尿管上段及中段上半部分结石的RLU手术。所有病例均通过这种新技术成功置入输尿管DJ管。将一根细孔窦道穿刺针插入腹膜后间隙，通过导丝将DJ管推送至输尿管下段。操控窦道穿刺针的尖端使其靠近输尿管切开部位以便于置入支架。将整个支架推送下去，仅使上端留在输尿管切开区域。然后，拔出导丝，将上端缓慢向上推送至肾盂。
172例患者均通过该技术成功置入DJ管。大多数情况下，支架可在<3分钟内（2至8分钟）置入。2例患者中，上端未能在肾盂内完全卷曲，但由于支架已通过输尿管切开部位，起到了内引流的作用。我们的病例均未出现尿漏。术后6 - 12周经膀胱镜取出支架。
该技术为RLU术后置入DJ管提供了一种简便、快速且安全的顺行方法。
