输尿管镜超声碎石清石系统碎石术后无管化的临床研究  

Clinical study of ureteroscope combined ultrasonic and penumatic lithotripsy without the placement of ureteral stent

作　　者：徐遵礼 朱建平 李品群 徐璐璐 马丽英 XU Zunli;ZHU Jianping;LI Pinqun;XU Lulu;MA Liying(The Secomd Surgery Department,the 946th Hospital of PLA,Yining 835000,China)

机构地区：[1]解放军第946医院外二科

出　　处：《西北国防医学杂志》2019年第12期751-755,共5页Medical Journal of National Defending Forces in Northwest China

摘　　要：目的:探讨输尿管镜超声碎石清石系统碎石术治疗输尿管中下段结石术后是否应常规留置双J管。方法:选择我院2016-06~2018-06行输尿管镜联合超声碎石清石系统碎石术治疗的不复杂输尿管中下段结石患者53例,随机分为2组,其中未置管组27例,术后不留置双J管,予坦索罗辛和托特罗定口服;置管组26例,术后常规留置双J管1个月。比较两组手术时间、术后住院时间、结石排出率等指标和术后血尿、尿路感染、尿路刺激征和肋腹部疼痛发生情况及疼痛视觉模拟评分,并记录不良事件发生情况。结果:未置管组平均手术时间为(25.1±6.7)min,置管组为(32.5±6.6)min,差异有显著统计学意义(P<0.01)。两组结石排净率均为100%。未置管组术后肋腹部疼痛发生率和疼痛视觉模拟评分均显著低于置管组(P<0.01)。置管组术后发生血尿、尿路刺激征、尿路感染例数均多于未置管组,差异均有统计学意义(P<0.05)。两组均无严重不良事件发生。结论:输尿管镜超声碎石清石系统碎石术治疗不复杂的输尿管中下段结石术后不留置双J管是安全的,且可以缩短手术时间,减少患者血尿、肋腹部疼痛、尿路刺激征和尿路感染的发生率。Objective:To evaluate whether post-operative ureteral stenting is necessary after ureteroscope combined ultrasonic and penumatic lithotripsy for the treatment of middle or distal ureteral calculi.Methods:Fifty-three patients with the middle or distal ureteral calculi who underwent uncomplicated ureteroscope combined ultrasonic and penumatic lithotripsy in our hospital from 2016-06~2018-06 were prospectively randomized into non-stented group(n=27,combination tolterodine with tamsulosin)and tented group(n=26).The stent was routinely placed in the treated ureter for 1 month.The outcomes were measured with operation time,hospital stay after operation,stone-free rates,postoperative patient symptoms,such as flank pain and visual analogue scale pain score,urinary irritative symptoms,infection and hematuria between the two groups.Adverse effects were recorded.Results:The mean operation time was(25.1±6.7)min for non-stented group and(32.5±6.6)min for tented group(P<0.01).The stone-free rate was 100%in both groups.The flank pain and visual analogue scale pain score had significantly decreased in patients with non-stented group compared to tented group(P<0.01).The incidence rate of hematuria,urinary irritative symptoms,infection in the stented group were higher than those in the non-stented group(P<0.05).No severe adverse event happened in both groups.Conclusion:Ureteroscope combined ultrasonic and penumatic lithotripsy for the treatment of middle or distal ureteral calculi can be safely performed without the placement of a ureteral stent.Patients without stents had less operative time,flank pain,urinary irritative symptoms,infection and hematuria.

关 键 词：输尿管结石 输尿管镜 超声碎石清石系统 双J管 

分 类 号：R693.4[医药卫生—泌尿科学]