研究目的：腫瘤引起的外因性輸尿管壓迫常必須尿液轉流。但是傳統逆行性雙J管的放置方法因阻塞而有很高的失敗率，也因此需要經皮腎臟造屢管。我們報告一種改良式又省時的逆行性雙J管置放方式。方法和材料：從2005年十月到2006年九月，我們實行46個女性病患及4個男性病患，她們都是惡性腫瘤導致輸尿管阻塞需要每3個月用輸尿管鏡更換一次雙J管。總共由一位醫師更換了80根雙J管。我們使用一種改良式的逆行姓更換雙J管方式，並分析統計這些病人的年紀、手術時間、疼痛指數及併發症。結果：我們成功的更換了75根雙J管，而有5根雙J管因為石頭阻塞在舊的雙J管內而導致失敗。平均手術時間是l6.05分鐘，平均疼痛指數為3.7分。全部病人皆是門診手術，而且全部46個女性病人皆是局部麻醉下完成，而4個男性病人則是靜脈全身麻醉下完成。術後病人無明顯併發症。結論：這種改良式手術花費較傳統經輸尿管鏡更換便宜，而且是個安全又有效率的方法。

A Novel Method for Replacing Double-J Ureteral Stents in Patients with Malignant Extrinsic Compression of the Ureter OBJECTIVES: Extrinsic ureteral obstruction caused by various malignancies often necessitates urinary diversion. Traditional retrograde replacement of double-J ureteral stents results in a high failure rate due to severe extrinsic compression, subsequently necessitating percutaneous antegrade placement. We report a modified, time-saving method for the retrograde replacement of double-J stents. MATERIALS AND METHODS: From October 2005 to September 2006, we treated 46 female and 4 male patients who had malignant extrinsic compression of the ureter and who required replacement of a double-J stent with ureteroscopy every 3 months. Eighty stents were replaced by a single surgeon. The method consists of gaining control of the distal end of the double-J stent by retrieving it to the urethral meatus with cystoscopic alligator clips [?], and then a guide wire is inserted into the distal end to the renal pelvis. Subsequently a new double-J stent is replaced in a retrograde manner through the guide wire. We analyzed these cases by age, operative time, pain scores, and complications. RESULTS: This technique was successfully performed in 75 cases, but it failed in 5 cases due to stone formation inside the previous double-J stent. The mean operative time was 16.05 (range, 12~37) minutes. The mean pain score was 3.7 (range, 1~8). All procedures were performed on an outpatient basis. All 46 female patients were treated under local anesthesia, while the 4 male patients was treated under intravenous general anesthesia. The postoperative course was smooth, and the stents were tolerated in all patients without significant discomfort or complications. CONCLUSIONS: This modified technique is considerably cheaper than traditional replacement under epidural or general anesthesia and is safe and effective.