输尿管软镜碎石术前预置输尿管支架的利弊研究  

作　　者：李王坚[1] 叶利洪[1] 陈永良[1] 

机构地区：[1]中国医科大学绍兴医院泌尿外科,312030

出　　处：《浙江临床医学》2018年第6期1030-1031,共2页Zhejiang Clinical Medical Journal

摘　　要：目的总结同期输尿管软镜联合经皮肾镜治疗肾结石患者中的护理要点。方法将拟行输尿管碎石术的患者，依据患者意愿、结石等情况，分为两组：A组45例，术前2周预置F6输尿管支架；B组36例，未预置输尿管支架，Ⅰ期行输尿管软镜术。结果A组45例患者，均Ⅱ期成功置入F12／14的输尿管软镜鞘，成功施行碎石术。B组36例患者，30例Ⅰ期成功施行输尿管软镜术，27例置入F10／12的输尿管软镜鞘，3例置入输尿管软镜鞘失败，直接沿导丝置入输尿管软镜入输尿管，完成碎石术，6例患者置入输尿管软镜失败，予置入输尿管支架，5例2周后成功进行Ⅱ期输尿管软镜术，1例患者考虑纯尿酸结石，予枸橼酸氢钾钠颗粒口服1个月后，结石完全消失。A、B两组在手术时间、住院日及结石治愈率方面无显著差异，A组无明显并发症，B组未使用输尿管软镜鞘者，1例出现肾周血肿，1例术后出现感染性休克，另有2例术后出现泌尿道感染所致发热，后均治愈。结论输尿管软镜碎石术前预置输尿管支架，有利于输尿管软镜鞘的置入，并且能置入较粗的输尿管软镜鞘，有利于提高手术的成功率，降低感染等并发症的发生。Objective To study the pros and cons ofureteral stent placement before flexible ureteroscopic lithotripsy. Methods 81 patients with upper urinary tract calculi were divided into two groups： group B （ without indwelling stent, n=36 ） and group A （ with indwelling stent, n=45 ） . They were treated with flexible ureteroscopic holmium laser. Results The one-time success rate of placement for ureteral access sheath in group A were significantly better than those in group B, in group A, all patients were successfully inserted in the UAS of the size of F12/14, without serious side effects, while in the group B, only 27 patients were successfully inserted in the sheath of the size ofF10/12, 6 patients were failed to finish the operation. In group B, one suffered the hematoma around the kidney, another one suffered septic shock and other two suffered fever after the operation, but all were cured successfully finally. Conelusion The preoperative indwelling ofureteral stents can effectively increase the success rate of flexible ureteroscopic lithotripsy.

关 键 词：输尿管支架 输尿管软镜 钬激光 软镜鞘 

分 类 号：R699[医药卫生—泌尿科学]