Ⅱ期手术前留置双J管对输尿管软镜碎石术治疗上尿路结石患者输尿管损伤和疼痛的影响

Effect of indwelling double J stent before stage II operation on ureteral injury and pain in patients with upper urinary calculi treated by flexible ureteroscopic lithotripsy

摘要:

目的 分析Ⅱ期手术前留置双J管对输尿管软镜碎石术（FURL）治疗上尿路结石患者输尿管损伤和疼痛的影响。方法 选取2020年1月－2023年11月该院收治的上尿路结石患者348例，根据留置双J管的时间不同，将患者分为2周组（n = 85）、3周组（n = 98）、4周组（n = 92）和未留置双J管组（n = 73）。2周组、3周组和4周组分别在术前2、3和4周留置双J管，未留置双J管组不留置双J管，4组均行FURL治疗，观察至术后1个月。比较4组患者手术情况、住院情况、结石清除效果、输尿管壁损伤情况、疼痛情况和并发症发生情况。结果 未留置双J管组手术时间明显长于2周组、3周组和4周组，差异有统计学意义（P < 0.05）。未留置双J管组镜鞘置入成功率、软镜置入成功率和术后2周结石清除率明显低于2周组、3周组和4周组，差异均有统计学意义（P < 0.05）。与4周组比较，2周组、3周组和未留置双J管组输尿管壁损伤1级的占比更高，输尿管壁损伤3级的占比更低，差异均有统计学意义（P < 0.05）。与未留置双J管组和4周组比较，2周组和3周组膀胱刺激征、尿路感染和肉眼血尿占比明显更低，差异均有统计学意义（P < 0.05）。结论 Ⅱ期手术前留置双J管，能够缩短FURL治疗上尿路结石的手术时间，提高镜鞘置入成功率、软镜置入成功率和结石清除率，相较于术前4周，术前2周和3周留置双J管，能降低输尿管壁损伤风险，具有较高的安全性。

Abstract:

Objective To analyze the effect of indwelling double J stent before stage II operation on ureteral injury and pain in patients with upper urinary calculi treated by flexible ureteroscopic lithotripsy (FURL).Methods A total of 348 patients with upper urinary calculi from January 2020 to November 2023 were selected. According to the different time of indwelling double J stent, the patients were divided into the 2 weeks group (n = 85), the 3 weeks group (n = 98), the 4 weeks group (n = 92), and non-indwelling double J stent (n = 73). The 2 weeks group, 3 weeks group and 4 weeks group had double J stent indwelled at 2, 3 and 4 weeks before the operation, respectively. The non-indwelling double J stent group did not have a double J stent indwelled. All four groups received FURL treatment and were observed until one month after the operation. The surgical conditions, hospitalization conditions, stone clearance effects, ureteral wall injury conditions, pain conditions and the occurrence of complications were compared in the four groups.Results The operation time of the non-indwelling double J stent group was longer than that of the 2 weeks group, 3 weeks group and 4 weeks group, and the difference was statistically significant (P < 0.05). The success rates of intraocular sheath insertion, flexible endoscope insertion and stone clearance 2 weeks after surgery in the non-indwelling double J stent group were significantly lower than those in the 2 weeks group, 3 weeks group and 4 weeks group, and the differences were statistically significant (P < 0.05). Compared with the 4 weeks group, the proportion of post-ureteroscopic lesion scale (PULS) grade 1 was higher in the 2 weeks group, 3 weeks group and the non-indwelling double J stent group, while the proportion of grade 3 was lower. The differences were statistically significant (P < 0.05); Compared with the non-indwelling double J stent group and the 4 weeks group, the proportions of irritation sign of bladder, urinary tract infection and gross hematuria in the 2 weeks group and the 3 weeks group were significantly lower, and the differences were statistically significant (P < 0.05).Conclusion The indwelling of a double J stent before stage II surgery can shorten the operation time of FURL for the treatment of upper urinary calculi, increase the success rate of endoscope sheath placement, flexible endoscope placement and stone clearance rate. Compared with 4 weeks before the operation, indwelling double J stent at 2 weeks and 3 weeks before the operation can reduce the risk of ureteral wall injury and has higher safety.