术前留置双J管时间对输尿管软镜治疗上尿路结石疗效的随机对照研究

Therapeutic effect of preoperative short-term indwelling double J tube in treatment of flexible ureteroscopy

摘要:

摘要：目的 探讨将双J管留置时间缩短为1周后，对输尿管软镜手术操作安全性和有效性的影响。方法 随机将患者分为对照组和试验组，再根据结石直径最大径分为1.0 cm、1.0～1.5 cm和1.5～2.0 cm组，分别留置双J管2周和1周。术前统计发生血尿和下尿路刺激症状的患者人数，以及使用解痉药物（盐酸坦索罗辛、索利那新）的人数，统计术中留置输尿管鞘周径、手术时间、手术并发症和结石清除率，根据结石大小分组进行统计分析。结果 试验组与对照组出现血尿及下尿路刺激症状者比较，差异无统计学意义，但对照组使用解痉药物明显高于试验组，试验组与对照组中留置12/14F和13/15F周径鞘比率，差异无统计学意义（P >0.05），但留置最大周径鞘14/16F输尿管鞘比率，差异有统计学意义（P <0.05），1.0 cm和1.0～1.5 cm两组术中平均手术时间、手术并发症、结石清除率试验组与对照组比较，差异无统计学意义（P >0.05），但在1.5～2.0 cm结石患者中，平均手术时间和结石清除率两组比较，差异有统计学意义（P <0.05），两组手术并发症比较，差异无统计学意义（P >0.05），术后拔管前复查B超结果显示，试验组结石残留率高于对照组。结论 短期留置双J管能明显减轻患者痛苦，且对输尿管软镜操作无明显影响，安全有效，但对于相对复杂和较大结石（>1.5 cm），应该常规时间留置双J管。

Abstract:

Abstract: Objective To investigate the efficacy and safety of short-term indwelling double J tube during operation of flexible ureteroscopy. Methods The patients were randomly divided into normal group (control group) and short-term group (experimental group). Each group was divided into 1 cm, 1.0 ~ 1.5 cm, 1.5 ~ 2.0 cm group, according to the maximum diameter of calculi, indwelling double J tube 2 and 1 week respectively. Preoperative statistics of the number of patients with hematuria and lower urinary tract irritation, and the number of patients taking antispasmodic drugs was gathered. Statistical data about the indwelling ureter sheath diameter, operation time, surgical complications, and stone clearance rate during the operation was statistically analyzed according to the stone size group. Results In patients with hematuria and urinary irritation symptoms, no significant difference in both groups, but the number of patients taking antispasmolytic drugs in experimental group was significantly more than that in control group. In both experimental group and control group, there was no significant difference in the usage rate of 12/14 F, 13/15 F ureter sheath diameter (P > 0.05), while the usage of the biggest 14/16 F ureter sheath diameter differ significantly (P < 0.05). In patients with 1.0 cm and 1.0 ~ 1.5 cm calculi, there was no significant difference in average operation time, surgical complications and stone clearance rate in both groups (P > 0.05). However, in patients with 1.5 ~ 2.0 cm calculi, there was significant difference with average operation time and stone clearance rate in both groups (P < 0.05). One month after the operation, the results of the ultrasound showed that the calculi residual rate in experimental group was higher than that in control group, and there was no significant difference with the complications in the two groups (P > 0.05). Conclusion It is safe and effective to choose short-term indwelling double J tube since less uncomfortable symptoms occur and there is no significant adverse impact during the operation of ureteroscopic lithotripsy. But for the relatively complex and large stones (>1.5 cm), it should be in accordance with the normal time indwelling double J tube.