供者十二指肠置管冲洗预防胰肾联合移植术后血尿18例报告  

Clinical report of 18 cases of preventing hematuria by tube flushing in donor duodenum after combined pancreas-kidney transplantation

作　　者：宋文利[1] 付迎欣[1] 冯钢[1] 沈中阳[1] 

机构地区：[1]天津市第一中心医院移植外科,300192

出　　处：《中华器官移植杂志》2009年第9期559-561,共3页Chinese Journal of Organ Transplantation

摘　　要：目的探讨供者十二指肠置管冲洗预防胰液膀胱引流式胰肾联合移植术后血尿的临床效果。方法糖尿病合并终末期肾病患者18例，接受胰液膀胱引流式胰肾联合移植术，其中早期的6例供者十二指肠中不放置冲洗管，后期的12例术中在供者十二指肠中放置冲洗管，即术中以10号T管经腹壁、膀胱置于供者十二指肠腔内，于膀胱腔内以5-0可吸收缝线固定冲洗管，用生理盐水确定冲洗管通畅后，缝合膀胱。此12例术后经冲洗管持续以生理盐水冲洗，速度为500ml／h，3d后，若冲洗液清亮，冲洗速度改为250ml／h，1周后改为间隔冲洗，并逐渐延长间隔时间，至术后14d停止冲洗。观察2d后，拔除导尿管。未放置冲洗管的6例如无膀胱出血，于术后7～10d拔除导尿管。结果常规放置冲洗管的12例中，术后仅1例（8．3％，1／12）在第7天停止膀胱冲洗后出现少量血尿，加强冲洗后血尿消失，术后14d顺利拔除导尿管，未再发生血尿。未放置冲洗管的6例中，4例（66．7％，4／6）出现严重血尿并发生膀胱填塞，明显高于常规放置冲洗管者（P〈0．05）。术中常规放置冲洗管者，术后仅1例（8．3％，1／12）发生泌尿系感染，而未放置冲洗管者，术后泌尿系感染发生率为66．7％（4／6），二者间的差异有统计学意义（P〈0．05）。结论供者十二指肠置管冲洗能显著减少胰液膀胱引流式胰肾联合移植术后血尿的发生。Objective To investigate the clinical effects of tube flushing in donor duodenum to prevent the hematuria post combined pancreas-kidney transplantation （SPK） with pancreatic fluid drainage through bladder. Methods 18 cases of diabetic patients associated with end-stage renal disease were subjected to combined pancreas-kidney transplantation with pancreatic fluid drainage through bladder,within which 12 cases were pre-placed douche tube in donor duodenum, while the other six were not. As for the cases in group with the tube, T tube of No. 10 was put in the donor duodenum through the abdominal wall and then bladder. After that the tube was fixed using 5-0 absorbable suture, then the bladder sutured if the tube was smooth confirmed by flushing with saline. After the operation, flushing was maintained using saline consecutively with the speed of 500 ml/h through the douche tubes of these 12 patients. Then the speed was changed to 250 ml/h 3 days later if the flushing fluid was limpid. One week later, changed to rinse intermittently and prolonged the flushing interval gradually. Till 14 days post the operation, flushing was ceased. After 2 days＇ survey, the urethral catheter was removed. As for the other 6 cases without douche tube, the urethral catheter was removed during 7-10 days after the operation if hematuria didn＇t occur. Results In the 12 cases with douche tube,there was only one patient （8. 3 %,1/12） having slight hematuria on the 7th day after the cessation of the bladder washout. Through strengthening the flushing, the hematuria disappeared. The urethral catheter was removed on the 14th day after the operation and the hematuria never happened again. In the group without the douche tube, 4 cases （66. 7 %,4/6） had serious hematuria complicated with bladder obturation. The incidence of that was obviously higher than in the group with the douche tube （P〈0. 05）. Only one patient （1/12, 8.3 %） in the group of regular insertion of douche tube had urinary system infection, but in the group

关 键 词：胰腺移植 肾移植 血尿 插管法 灌洗 

分 类 号：R686[医药卫生—骨科学]