Chow S H, LaSalle M D, Stock J A, Hanna M K
Children's Hospital of New Jersey-Saint Barnabas Health Care System, Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA.
J Urol. 1998 Sep;160(3 Pt 2):1001-3.
Indications for the use of external abdominal drains after ureteral reimplantation are not well defined. We determine the nature of the drainage fluid as well as the current use of drains by pediatric urologists.
We prospectively evaluated 15 consecutive patients 7 months to 19 years old who underwent unilateral or bilateral intravesical ureteroneocystostomy for primary vesicoureteral reflux. All patients were treated with a urethral Foley catheter and closed suction Jackson-Pratt abdominal drain. Fluid from the Jackson-Pratt drain and Foley catheter was analyzed for urea and creatinine on postoperative day 1, and compared to serum values. The Foley catheter was removed after the urine became clear, and the Jackson-Pratt drain was removed after drainage was 5 ml. or less for 12 hours. In addition, a questionnaire was distributed to 268 pediatric urologists to determine current practice regarding the use of routine postoperative drains.
Urea and creatinine from the Jackson-Pratt drains in all 15 patients were consistent with serum values. The Foley catheter and Jackson-Pratt drain were removed an average of 3 and 4 days postoperatively, respectively. There were 186 responses from the 268 questionnaires distributed (69.4%). Of the pediatric urologists surveyed 70.4% performed intravesical ureteral reimplantation exclusively, 5.9% extravesical reimplantation exclusively and 23.7% both techniques. Of the group surveyed 73.1% placed external abdominal Jackson-Pratt or Penrose drains, although 26.5% of those who routinely used external drains believed that they were probably unnecessary. Of the physicians who placed drains 53.7% believed that the drainage fluid had some component of urine.
In our small prospective study group we demonstrated that external abdominal drainage fluid is consistent with serum despite the popular belief that it may have some component of urine. The gynecological literature has shown repeatedly that there is no increase in morbidity after radical hysterectomy and pelvic lymph node dissection when no external abdominal drains are used. Although to our knowledge there are no previous reports of drain use after ureteral reimplantation, 26.9% of pediatric urologists currently do not place external abdominal drains with no apparent increase in morbidity. Larger prospective cohorts with long-term followup are needed to address adequately the issue of whether drains are needed after uncomplicated ureteral reimplantation.
输尿管再植术后使用腹部外引流的指征尚不明确。我们确定了引流液的性质以及儿科泌尿科医生目前对引流管的使用情况。
我们前瞻性评估了15例年龄在7个月至19岁之间的连续患者，这些患者因原发性膀胱输尿管反流接受了单侧或双侧膀胱内输尿管膀胱吻合术。所有患者均接受尿道Foley导尿管和封闭式负压吸引Jackson-Pratt腹部引流管治疗。在术后第1天分析Jackson-Pratt引流管和Foley导尿管引出的液体中的尿素和肌酐，并与血清值进行比较。尿液变清后拔除Foley导尿管，引流液连续12小时少于5毫升或更少时拔除Jackson-Pratt引流管。此外，我们向268名儿科泌尿科医生发放了一份问卷，以确定目前术后常规使用引流管的情况。
所有15例患者Jackson-Pratt引流管引出的尿素和肌酐与血清值一致。Foley导尿管和Jackson-Pratt引流管分别平均在术后3天和4天拔除。发放的268份问卷中有186份得到回复（69.4%）。在接受调查的儿科泌尿科医生中，70.4%仅进行膀胱内输尿管再植术，5.9%仅进行膀胱外再植术，23.7%两种技术都采用。在接受调查的人群中，73.1%放置了腹部外Jackson-Pratt或Penrose引流管，尽管26.5%经常使用外引流管的医生认为可能不需要放置。在放置引流管的医生中，53.7%认为引流液中有一部分是尿液。
在我们这个小的前瞻性研究组中，我们证明了尽管人们普遍认为腹部外引流液可能含有部分尿液成分，但实际上它与血清成分一致。妇科文献反复表明，在根治性子宫切除术和盆腔淋巴结清扫术后不使用腹部外引流管时，发病率并没有增加。虽然据我们所知，以前没有关于输尿管再植术后使用引流管的报道，但目前26.9%的儿科泌尿科医生不放置腹部外引流管，发病率也没有明显增加。需要更大规模的前瞻性队列研究并进行长期随访，以充分解决单纯输尿管再植术后是否需要引流管的问题。
