目的:探讨自引流带螺纹输尿管支架在肾移植受者肾移植中的临床安全性和有效性。
方法:本研究为北京大学人民医院泌尿外科2022年11月至2024年1月的前瞻性队列临床研究。输尿管支架带线组,其中手术期间在输尿管支架的膀胱端使用20-30cm的2-0Mersilene缝合线。手术后的第9天,当移除导管时,连接到输尿管支架末端的缝合线随尿液从尿道口排出。输尿管支架可以与缝合线一起移除。至于膀胱镜组,肾移植期间常规放置输尿管支架,术后局部浸润麻醉下经膀胱镜取下输尿管支架。观察比较两组拔除导尿管过程中疼痛评分[数值评定量表(NRS)-11]及尿路感染发生率。t检验比较两组患者留置输尿管支架和取出输尿管支架的疼痛评分,采用卡方检验比较两组术后3个月内泌尿系统并发症的发生情况。P<0.05被认为具有统计学意义。
结果:截至2024年3月,所有受者术后平均随访6个月(3~12个月)。共纳入46例肾移植患者,带线输尿管支架组21例,膀胱镜组25例。两组年龄分布差异无统计学意义,男女比例,死者与活体移植。肾移植术后三个月,膀胱镜组尿路感染15例,输尿管支架带线组尿路感染4例(P=0.007)。没有明显的尿瘘,伤口感染,或输尿管狭窄发生在任何一组。无支架相关并发症,支架迁移,或观察到结石形成。膀胱镜组留置输尿管支架术后膀胱痉挛症状评分为4.4±2.5和4.6±2.4,差异无统计学意义(t=0.29,P=0.773)。然而,两组患者输尿管支架取出过程中的疼痛评分分别为4.9±1.6和3.0±1.0,分别,差异有统计学意义(t=5.017,P<0.001)。膀胱镜组留置和取出输尿管支架的总费用为6452.0元(5539.5,6452.0元)和3225.0元(3225.0,3225.0元),分别,差异有统计学意义(P<0.001)。
结论:与传统移植肾输尿管支架相比,带缝线的自放电输尿管支架技术更简单,具有较短的输尿管支架嵌入时间,减少膀胱痉挛的症状,显着降低了导管插入的成本,术后泌尿系统并发症较少。是一种值得推广的改良手术方法。
OBJECTIVE: To explore the clinical safety and effectiveness of self-draining ureteral stent with thread in kidney transplant recipients in renal transplantation.
METHODS: This study is a prospective cohort clinical study in the Department of Urology of Peking University People\'s Hospital from November 2022 to January 2024. The ureteral stent with thread group, in which a 2-0 Mersilene suture of 20-30 cm was used at the bladder end of the ureteral stent during the operation. On the 9th day after the operation, the suture attached to the end of the ureteral stent was expelled out of the urethral orifice with the urine when the catheter was removed. The ureteral stent could be removed along with the suture. As to the cystoscope group, a ureteral stent was routinely placed during kidney transplantation, and the ureteral stent was removed under local infiltration anesthesia through cystoscopy after the operation. The pain scores [numerical rating scale (NRS)-11] during catheter removal and the incidence of urinary tract infections were observed and compared between the two groups. t test was used to compare the pain scores of indwelling ureteral stents and ureteral stents removal between the two groups, and Chi-square test was used to compare the occurrence of urinary system complications within 3 months after operation between the two groups. P < 0.05 was considered statistically significant.
RESULTS: As of March 2024, all the recipients were followed up for an average of 6 months (3 to 12 months) postoperatively. A total of 46 kidney transplantation patients were included, with 21 in the ureteral stent with thread group and 25 in the cystoscope group. There were no statistically significant differences between the two groups in age distribution, male-to-female ratio, and deceased versus live donor grafts. Three months after renal transplantation, there were 15 cases of urinary tract infection in the cystoscope group and 4 cases in the ureteral stent with thread group (P=0.007). No significant urinary fistula, wound infection, or ureteral stenosis occurred in either group. No stent-related complications, stent migration, or stone formation were observed. The postoperative bladder spasm symptom scores for indwelling ureteral stents in the cystoscope group and the ureteral stent with thread group were 4.4±2.5 and 4.6±2.4, respectively, with no statistically significant difference (t=0.29, P=0.773). However, the pain scores during ureteral stent removal were 4.9±1.6 and 3.0±1.0 in the two groups, respectively, with a statistically significant diffe-rence (t=5.017, P < 0.001). The total costs of indwelling and removing ureteral stents in the cystoscopy group and the ureteral stent with thread group were 6 452.0 (5 539.5, 6 452.0) yuan and 3 225.0 (3 225.0, 3 225.0) yuan, respectively, and the difference was statistically significant (P < 0.001).
CONCLUSIONS: Compared with the conventional transplanted kidney ureteral stent, the self-discharge ureteral stent technique with sutures is simpler, has a shorter ureteral stent inlay time, reduces the symptoms of bladder spasms, significantly reduces the cost of catheterization, and has fewer postoperative urinary system complications. It is a worthy improved surgical method to be promoted.